1. When caring for a patient with cardiac disease who has just entered the second stage of labor, the nurse understands that the management of the patient will likely include:
A. doubling the rate of the pitocin infusion to shorten the length of the second stage of labor.
B. monitoring the IV infusion rate so that intake does not exceed output during labor.
C. evaluating the rate of fetal descent by frequent cervical examinations.
D. decreasing the length of the second stage of labor by performing a forceps or vacuum-assisted delivery.
ANSWER RATIONALE
A. The rate of infusion of pitocin would never be doubled at this point in labor.
B. During the second stage of labor, there is very little measurable output, while the IV infusion rate will continue as ordered.
C. Cervical exams would be done as indicated by the progress of the patient.
D. The goal of management with this patient is to shorten the second stage of labor. Appropriate management could include: 1) spinal anesthesia, 2) episiotomy, and 3), forceps delivery.
2. The most effective breathing pattern during the transition phase of labor is:
A. deep abdominal breathing.
B. slow, rhythmic chest breathing.
C. "pant-pant-pant blow" breathing.
D. a light, rapid pant.
ANSWER RATIONALE
A. This type of breathing is not usually used during this phase.
B. This type of breathing may be used prior to the transition phase when the labor is less intense.
C. This pattern-paced breathing is used to enhance the concentration of the laboring women during a time when the contractions are most intense.
D. This method may be used to stop the urge to push during a contraction.
3. Rosemary, 36 weeks pregnant, is admitted to the hospital with 3+ proteinuria, a blood pressure of 160/90, and marked edema. Rosemary is started on IV magnesium sulfate. The purpose of this medication is to:
A. prevent seizures and inhibit peripheral neuromuscular transmission.
B. induce uterine muscle contractions to control the progress of labor.
C. act as a predominant betaminic agent on the smooth muscle of the uterus.
D. act as an antihypertensive sole agent.
ANSWER RATIONALE
A. Magnesium sulfate, an anticonvulsant and smooth muscle relaxant, is given to prevent convulsions.
B. An effect of magnesium sulfate is to inhibit smooth muscle contractions.
C. The predominant action of magnesium sulfate is to depress neuromuscular transmission.
D. The hypotensive effect of magnesium sulfate is a side effect of the drug.
4. Barbara's blood pressure reading at 34 weeks of pregnancy is elevated. When discussing pregnancy-induced hypertension with her, the nurse instructs her to report back immediately if she notes symptoms or signs of:
A. weight gain of 1 pound a week.
B. intractable headache or visual disturbances.
C. development of a backache with fatigue.
D. episodes of heartburn with indigestion.
ANSWER RATIONALE
A. Weight gain of one pound a week is the expected rate of gainin later pregnancy.
B. Severe headache and visual disturbances are considered two of several warning signs of preeclampsia.
C. Development of a backache with fatigue is not an abnormal occurrence.
D. Heartburn with indigestion is an expected discomfort of later pregnancy.
5. Rose has been having persistent late decelerations with moderate bradycardia while in labor. A fetal scalp pH was performed. The nurse explained to the patient that no intervention was needed at this time following a pH result of:
A. 7.0 to 7.05
B. 7.1 to 7.15
C. 7.2 to 7.25
D. 7.3 to 7.35
ANSWER RATIONALE
A. This is in the acidotic range.
B. This is in the acidotic range.
C. This is in the suspected acidotic range for fetal scalp pH.
D. The normal fetal scalp pH is 7.26 and above; borderline acidosis is 7.20 to 7.25; and for pH levels less than 7.15, an acidosis exists.
6. When developing a plan for the pregnant woman, the instructions include that lying on her left side will:
A. help alleviate backache.
B. help her breathe better.
C. prevent pelvic congestion.
D. prevent supine hypotension.
ANSWER RATIONALE
A. This not directly related to this problem.
B. This not directly related to this problem.
C. This not directly related to this problem.
D. The growing uterus may press on the inferior vena cava when the pregnant woman is supine. This reduces blood flow to the right atrium and a ower blood pressure, causing dizziness.
7. Betamethasone is ordered and given to a patient diagnosed with preterm labor at 34 weeks. In evaluating the effects of this medication, the nurse would note that it is given to:
A. decrease the intensity of the contractions.
B. delay the progress of preterm labor.
C. suppress the maternal immune response.
D. facilitate maturation of the fetal lung.
ANSWER RATIONALE
A. Betamethasone does not impact on the progress of labor.
B. Betamethasone does not impact on the progress of labor.
C. Betamethasone does not affect the maternal immune response.
D. The incidence and severity of respiratory distress syndrome has been found to be reduced if glucocorticoids (eg, betamethasone) are administered to the mother at least 24 to 48 hours before birth.
8. When developing a plan for the patient receiving a riodrine hydrochloride for premature labor, the nurse would include having which of the following available as an antidote?
A. propranolol (Inderal)
B. magnesium sulfate
C. Phenobarbital
D. calcium gluconate
ANSWER RATIONALE
A. Ritodrine hydrochloride stimulates Beta-adrenergic receptors, causing relaxation of smooth muscles. Propranolol is an adrenergic blocking agent and could be used to stop the effects of ritodrine hydrochloride.
B. This would not be used as an antidote because it is not an adrenergic blocking agent.
C. This would not be used as an antidote because it is not an adrenergic blocking agent.
D. This would not be used as an antidote because it is not an adrenergic blocking agent.
9. Diane and Ned Rampart have decided to practice natural family planning. They ask the nurse about the Billings method. The nurse explains that the Billings method is performed by:
A. taking the BBT (basal body temperature) daily to determine ovulation
B. checking for spinnbarkheit and the BBT.
C. evaluating the amount and consistency of cervical mucus.
D. monitoring for mittelschmerz signs to determine ovulation.
ANSWER RATIONALE
A. This is a technique which might be used by couples practicing natural family planning, but it does not represent the Billings method.
B. This is a technique which might be used by couples practicing natural family planning, but it does not represent the Billings method.
C. The Billings method, also called the cervical mucus method or the ovulation method, depends on the characteristic changes in the cervical mucus at the time of ovulation.
D. This is a technique which might be used by couples practicing natural family planning, but it does not represent the Billings method.
10. When teaching a family about the side effects of diuretics for their child, the nurse encourages giving tomato juice and meats. Which of the following electrolytes would the parents describe as needing replacement?
A. Sodium
B. Potassium
C. Chlorides
D. vitamins
ANSWER RATIONALE
A. The excretion of this substance is not increased like that of potassium.
B. Diuretics increase the excretion of potassium; it will have to be replaced.
C. The excretion of this substance is not increased like that of potassium.
D. The excretion of this substance is not increased like that of potassium.
11. The nurse midwife performs a procedure in the last trimester to determine fetal position, lie, and presentation. The nurse would describe this procedure as:
A. an ultrasound test.
B. a pelvic exam.
C. Leopold's maneuvers.
D. a fundal sizing.
ANSWER RATIONALE
A. The nurse midwife would not perform this procedure.
B. This would not determine the fetal position or lie.
C. Fetal lie, presentation, position, and engagement can be determined by abdominal palpation of the mother.
D. This would not determine the fetal position or lie.
12. Elizabeth's first prenatal visit, 8 weeks after her last menstrual period, revealed a soft cervix, Chadwick's sign, and an enlarged uterus. When analyzing these findings, the nurse understands that they are considered:
A. presumptive signs of pregnancy.
B. probable signs of pregnancy.
C. possible signs of pregnancy.
D. positive signs of pregnancy.
ANSWER RATIONALE
A. This is not an accurate description.
B. The described findings are characteristic of the first trimester of pregnancy and are labeled the presumptive signs of pregnancy.
C. This is not an accurate description.
D. This is not an accurate description.
13. Rita, a 30-year-old gravida 3, para 2, is admitted to labor and delivery in active labor. She has a hypertonic uterus with severe pain. It is most important for the nurse to:
A. monitor contractions and the fetal heart rate.
B. prepare for an immediate cesarean section.
C. perform a vaginal exam to evaluate her progress.
D. provide psychological support to the mother.
ANSWER RATIONALE
A. The priority of care is monitoring fetal well-being and maintaining the cardiovascular status of the mother.
B. With a hypertonic uterus, the placenta is not well perfused between contractions and the fetus is subjected to increasing periods of hypoxia. The usual option is a C/S.
C. The priority of care is monitoring fetal well-being and maintaining the cardiovascular status of the mother.
D. The priority of care is monitoring fetal well-being and maintaining the cardiovascular status of the mother.
14. When working with the pregnant patient, the nurse bases psychosocial support on the patient's ability to adapt to the maternal role. One of the first psychosocial maternal role tasks is to:
A. establish realistic goals for herself as a mother.
B. incorporate the idea of a child into her body image.
C. prepare for the physical separation at the time of birth.
D. accept the growing fetus as distinct from herself.
ANSWER RATIONALE
A. This is a later achievement for the pregnant woman.
B. One of the earliest maternal role tasks is to "accept the biologic fact of pregnancy" and to "incorporate the idea of a child into her body image."
C. This is a developmental task of the third trimester.
D. This is a developmental task of the second trimester.
15. Maureen Limberti, aged 24, and 39 weeks gestation, is having contractions every 15 minutes. The characteristic that will help her distinguish the difference between early and false labor is when she:
A. falls asleep and contractions stop.
B. notes that the contractions start in the back.
C. realizes walking will intensify the contractions.
D. experiences gas-like abdominal pains.
ANSWER RATIONALE
A. Braxton-Hicks contractions, or false labor, are mild, intermittent, painless contractions which occur throughout the second half of pregnancy. Women often obtain relief from them by walking or lying down.
B. This is a characteristic of early labor and is often accompanied by "bloody show," which is not seen in false labor.
C. This is a characteristic of early labor and is often accompanied by "bloody show," which is not seen in false labor.
D. This is a characteristic of early labor and is often accompanied by "bloody show," which is not seen in false labor.
16. The purpose of Kegel’s exercise is:
A. improve the tone of the rectus abdominus.
B. enhance the mother's uterine contractions.
C. increase strength in the lower back and abdomen.
D. strengthen the muscles around the perineal area.
ANSWER RATIONALE
A. This is not the best reason for performing these exercises.
B. This is not the best reason for performing these exercises.
C. This is not the best reason for performing these exercises.
D. The purpose of Kegel's exercises is to strengthen the muscles around the perineal area.
17. Stephanie Curtain, age 25, is having strong contractions occurring every 2 minutes and lasting 60 to 90 seconds. She feels frustrated, starts to tremble, and is afraid she is losing control. The nurse identifies that she is moving into the:
A. latent phase of labor.
B. active phase of labor.
C. transition phase of labor.
D. second phase of labor.
ANSWER RATIONALE
A. The latent phase of labor is characterized by mild, irregular contractions, with the mother excited and alert.
B. The active phase of labor is characterized by contractions every 3 to 5 minutes, moderately strong, with women becoming more focused inward.
C. These are characteristic findings of the final or transition phase of the first stage of labor.
D. There is no second "phase" of labor. It is the second stage of labor.
18. Your patient is being maintained on lithium therapy for bipolar disorder. Her serum lithium level is 0.9 mEq/L. You assess this level as:
A. too low to be effective.
B. within the therapeutic range.
C. acceptable for acute episodes only.
D. a toxic indicator.
ANSWER RATIONALE
A. This is a suggestion which would not be appropriate given the level of the blood.
B. The therapeutic range for effective ongoing management of the patient on lithium carbonate can be as low as 0.6 mEq/L or as high as 1.5 mEq/L.
C. This is a suggestion which would not be appropriate given the level of the blood.
D. This is a suggestion which would not be appropriate given the level of the blood.
19. Karen, a gravida 2, para 1, is admitted for generalized edema, Proteinuria of +2, and an elevated blood pressure. She is placed on magnesium sulfate and is receiving 2 grams/hour IV. Preparing to mix the next liter of medication, the nurse assesses her, finding absent reflexes and a respiratory rate less than 10 breaths per minute. The first nursing action is to:
A. slow down the magnesium sulfate infusion.
B. stop the medication and monitor progress.
C. stop the magnesium and give calcium gluconate.
D. call the physician and have calcium gluconate in the room.
ANSWER RATIONALE
A. The patient has magnesium toxicity and should not receive more of the medication.
B. The medication should be stopped but the physician should be notified.
C. The medication should be stopped but the physician should be notified.
D. Absent reflexes and a respiratory rate of 10 per minute or less indicate magnesium toxicity and the antidote (calcium gluconate) should be in the patient's room. The physician should also be notified at once.
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