Delivery Room

I

DELIVERY ROOM -l-

Directions: Selectthe besl answer tor each of the following questions. Situation 1: A nurse is caring for severalclients in the delivery room who are in the tifst stage of labor.

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1.

A client'svaginalexaminationrevealscervicaldilationof 3 cm, 1oo%effacement, and positiveferning.Based on theselindings,the nurseconcludesthat this clientis in whichphaseof the firststageo{ labor? a. Latentphase phase c. Transitional b. Activephase phase d: Expulsive

2.

Assessmentof a primigravid clientrevealsthat her cervixis 4 cm dilatedand 100%effacedwithcontractions occurringevery4 minutes.What phaseol laboris she in? phase a, Latentphase c. Transitional b. Activephase d. Expulsivephase

3.

When caringlor anotherclient,the nursedocumentscervicaldilationof I cm and intensecontractions lasting 45 to 60 secondsand occurringaboutevery2 minutes.Basedon theselindings,the nurseshouldrecognize that this clientis in whichphaseof labor? a. Lalentphase phase c. Transitional b. Activephase d. Expulsivephase

4.

A multipara'sinitialexaminationrevealsher cervixto be at 8 cm, completelyetfaced(1OO%), and at Ostation. What ohaseot laboris she in? a. Latentphase phase c. Transitional b, Activephase d. Expulsivephase

5.

What is the shortestbut mosl difficultpartof this stage? a. Latentphase b. Activephase

phase c. Transitional d. Expulsivephase

Situation 2: The nurse knows that labor is the series of eventsby which uterinecontractionsand abdominat pressure expel the fetus and placentafrom the woman,s body. 6.

7.

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Laboris dividedintohow manystages? a. Five b. Three

c. Two

The firststageof laborendswith whichof the following? a. Whenthe clientis transferred to her postpartumbed b. Afterthe birthof the placenta

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d. Four

c. Whenthe clientis fullydilated d. The birthof the baby

8.

What marksthe beginningof the secondstage,and what marksthe end? a. Cervicaldilationof 7 to I cm; completecervicaldilation b. Completecervicaldilation;deliveryof the neonate c. Cervicaldilationof 7 to I cm; deliveryof the placenta d. Completecervicaldilation;deliveryol the placenta

9.

The thirdstageof laborbeginswithwhichof the tollowing'/ a. Whenthe clientis transferred to her oostpartumoeq b. Afterthe birthof the placenta c. Whenthe clientis fullydilated d. The birthof the babv

10. The nursecheckslor fetaldescent,flexion,internalrotation,extension,externalrotation,and expulsion.What do thesetermsdescribe? a. Factorsthat determinefetalposition c. Cardinalmovementsof labor b. Factorsaffectinglabor d. Phases.ofthe firststageof'labor Situation 3: Before going to the DeliveryBoom Area tor their clinical duty, a clinical instructor gives the students a short quiz pertainingto the care of clients in labor. 1 1. A nulliparousclienthas been in the latentphaseof the firststageof labgrfor severalhours.Her latentphase may be consideredprolongedafter: a. 6 hours. b . 1 0h o u r s . c. 14hours. d, 20 hours. 12. A primigravidclientis in earlylabor.The client'scervicalexamination wouldrevealwhichof the following? a. 2 cm dilated;1OO%effacedat O station c. 2 cm dilated;50% effacedat +'1station

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b 13.

4 to 5 cm dilated; 80% effaced at -1 station

d.

3 cm dilated; 50% effaced at O station

For a client who's a primigravida,the nurse would expect that the second stage would normally last how long?

a. tt.

Approximately 2 hours Lsss than t hour

c. 4 hours d. 3 hours

14. Durjnglhe secondstage,how frequentlyshouldthe nurseassessthe clienfs uterinecontractions? a. Every5 minutes c, Every30 minutes b. Every15 minutes d. Every60 minutes .15.

How can the nursemostelfectivelydeterminethe durationof the client,scontractions? a By timingthe periodbetweenone contractionand the beginningof the next contraction b. By timingthe periodfromthe onsetof uterinetighteningto uterjnerelaxation c. By timingthe periodfrom the increment(building-up) phaseto the acme (peak)phase Q. By timingthe periodfromthe acme (peak)phaseto the decrement(letting:down) phase

Situation 4: A nurse is discussing Leopold's maneuversto a group of students. 16. When performingLeopold'smaneuvers,whichof the followingwouldthe nurseask the clientto do to ensure optimalcomfortand accuracy? a. Lie on her leftside c. Emptyher bladder b . D r i n ka f u l lg l a s so t w a t e r d . B r e a t h ed e e p l v '17. The nurseperformsthe tirstmaneuverto do whichof the following? a. ldentifythe degreeof letal descentand flexion b. Determjnewhetherthe fetalheadis at the pelvicintet c. Determinewhat is in the fundus d. Locatethe tetalbackand spine 18.

Whenperforming thesecondmaneuver, the nurseexplajnsthatthismaneuveris donefor whjchof the followinq reasons? a. To locatethe backof the fetus b. To distinguishbetweena breechand a ceohalicoresentation e. To locatethe fetalcephalicprominence d. To determinewhetherthe fetalpresentingpart is engaged

19. The nurseperformsthe thirdmaneuverto do whjchof the following? a. Determinewhetherthe fetalpresentingpart is engaged b. Locatethe fetalcephalicprominence c. Distinguish betweena breechand a cephalicpresentation d. Locatethe positionof the fetalarmsand legs 20.

When performingthe fdurthmaneuver,the nurseexplainsthatthismaneuveris donefor whichof the followinq reasons? a. To identifythe degreeof {etaidescentand flexion b. To determinewhetherthe fetalhead is at the pelvicinlet c. To determinewhat is in the f undus d. To locatethe fetalbackand spine

Situation 5: A nurse is caring for severalclientswho have preexistlngor newly acquiredillnessesand have developedcomplicationsof pregnancy. 21.

What is the primarynursingdiagnosisfor a clientwith a rupturedectopjcpregnancy? a. Anticipatory grieving c. pain b. Deficientfluidvolume d. Anxiety

22.

The nurseis assessinga pregnantwoman.Whichsignsor symptomsindicatea hydatidiform mole? a. Rapidtetalhearttones b. Abnormallyhigh humanchorionicgonadotropin (HCG)levels c. Slow uterinegrowth d. Lackof symptomsof pregnancy

29. A multiparous clienthas painlessvaginalbleeding.Ultrasonography showsthatan edgeof her placentameets but doesn'toccludethe rim of the cervicalos. Thisfindingsuggests: a. abruptioplacentae. c. a low * lyingplacenta. b. marginalplacentaprevia. d. partialplacentaprevia.

24.

A clientis admittedto the facilityin pretermlabor.To halt her uterinecontractions, the nurse expectsthe physicianto prescribe: a, betamethasone(Celestone). c. ergonovine(ErgotrateMaleate). b. dinoprostone(Prepidil). d. ritodrine(yutopar).

25.

A clienthas activegenitalherpes.Whichtype of birthshouldthe nurseanticipatefor thisclient? a, [,4idforceps c. Induction b. Low forceps d. Cesarean

Situation 6: A l7 - year - old primigravidis admittedto the labor unit at 39 weeks, She tells the nurse that her physician said that she neededto be treatedtor high blood pressure. 26.

Whichassessmentfindingwouldsupportthe diagnosisof pregnancy- inducedhypertension (plH)? a. Pink- tingesputum c. Weightlossof 2 pounds b , P r o t e i ni n t h e u r i n e d . D e p e n d e natn k l ee d e m a

27.

when preparingthe roomfor admission,whichof the followingwouldthe nurseobtain? a. Oxytocininfusionsolution c. Portableultrasoundmachine b. Disposabletongueblades d. Paddingfor the side rails

28.

Which laborroomassignmentwouldthe nursegiveto the client? a. Closeto the nurseryso she,llmaintainhopeof a posiflveoutcome b. In a back hallwaywherethereis a quiet,privateroom c. Acrossfromthe nurses'stationso that she can be observedclosely d. Nearthe elevatorso thatshe can bs transportedquickly

29

Whichof the followlngwouldalertthe nursethatthe clientmay be aboutto experiencea seizure? a. Hyporeflexia c. Hypothermja b. Epigastricpain d. Decreasedcontractionintensiry

30

The clientbeginsto havea seizure.The firstnursingactionby the nurseshouldbe to: a. Insertan airway c. pad the side railsof the bed b. callfor immediateassistance d. turn the clientto her leftside

Situation 7: MagnesiumSulfate is the drug of choice to preventeclampsia. 3'1. This drugacts as whichof the following? a. Sedative/Hypnotic b. CentralNervousSystemDepressant 32.

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34.

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c . Antihypertensive d . PeripheralVasodilator

This drug is givento do whichof the following? a. Increasediuresis b. Slowthe processof labor

c. Reducebloodpressure d. Preventseizures

lts actionoccursat whichof the tollowingsites? a . N e u r a-l m u s c u l aj ru n c t i o n s b . D i s t arl e n a tl u b u l e s

c. Centralnervoussystem(CNS) d. Myocardialfibers

What is the therapeuticrangeof thisdrug? a . 1 t o 4 m g / 1 0 0m L b . 5 t o 8 m g / 1 0 0m L

c , 9 t o 1 2 m g / 1 0 0m L d , 1 3 t o 1 6 m g / 1 0 0m L

What is the antidotefor magnesiumtoxicity? a. Diazepam b, Nifedipine

c. Calclumgluconate d. Phenytoin

Situation 8t A client is to have a lumbar epidural block to relieve labor pain. 36

Beforeanesthesiaadministration, the nurseinstructsthe clientto assumewhichof the followinooositions? a. Prone c. Side_ lvino b. Knee- to * chest d. Lithotomy

37

The nurseanticipatesthatthe anesthesiologist will injectthe anestheticagentintothe: a. subarachnoid space. tr. area betweenthe subarachnoid spaceand the dura mater. c. area betweenthe dura materand the liqamentumflavum. d. ligamentum flavum.

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' 38.

Whichvitalsign is mostlikelyto reflectan adverseeffectof this anesthesia? a. Temperature c. Respiratory rate b. Bloodpressure d. Heartrale

39.

After administration of the epiduralblock,for which of the followingwouldthe nursefrequentlyassessthe client? a. Relaxationof the uterus c. Hypotension i. b. Hypeneflexia d. Spinalheadache ..\

40.

Whichot the followingwouldthe nurseanticipatethat the physicianwill orderif the clientdevelopsthe most commonadverseeffectto this anesthesia? a. Atropinesulfate c. Epinephrine b. I\4ethylergonovine d. Ephedrinesullate

Situatiori g: A nurse is providing care for a prihigravid client with insulin -.dependent diabetesmellitus. 41. The nurseshouldinstructthe clientthatfor mostpregnantclientswith insulin- dependentdiabetesmellitusj a. nonstresstestingis pedormedweeklyuntil32 weeks'gestation. b. inductionof laboris begunat 34 weeks'gestation. c. contractionstresstestingis performedweekly. d. weeklyfetalmovementcounlsare madeby the mother. 42.

The nurseis teachingher about insulinrequirements duringpregnancy.Which guidelineshouldthe nurse provide? a. "lnsulinrequirements don'tchangeduringpregnancy.Continueyour currentregimen." b. "lnsulinrequirements usuallydecreaseduringthe lasttwo trimesters." c. "lnsulinrequirements usuallydecreaseduringthe firsttrimester." d. "lnsulinrequirements increasegreatlyduringlabor."

43.

The clientasksthe nurseif her insulin- dependentdiabetesmellituswillaffecther delivery.The nurseshould knowthat: a. it's too earlyto tell. c. the deliverymustbe by cesarean. b. the motherwillcarryto termsafely. d. the deliverymay needto be inducedearly.

44.

The nurseshouldexplainto the clientthat laboris usuallyinducedto preventneonatal: a. ketoacidosis. c. stillbirth. ia. d. hyperglycem b. asphyxia.

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45. When developinga teachingplanfor the clientaboutmonitoringbloodglucosecontroland insulindosages at home,whichof the followingwouldthe nurseexpectto includeas a desiredtargetrangefor bloodglucose levels? a. 140to 160 mg/dLone houraftermeals. b. 110 to 140 mg/dl beforemealsand bedtimesnacks. c. 60 to 100 mg/dLbeforemealsand bedtimesnacks. d. 40 to 60 mo/dLbetween2:00 and 4:00 pM. Situation 10: Hemorrhage is one of the most important causes of maternal mortality associated with childbearing. 46. What is the maximumbloodlossconsideredwithinnormallimits? a. 300mL b . 5 0 0m L c . 8 0 0m L 47.

48.

d . 1 , 0 0 0m L

How much bloodis lostduringa vaginalbirth? a. between100 mL and 300 mL b . b e t w e e n3 0 0m L a n d5 0 0 m L

c. between600 mL and 800 mL d . b e t w e e n8 0 0 m L a n d 1 , 0 0 0 m L

How much bloodis lostdurrnga cesareanbirth? a . l e s st h a n5 0 0m L b. between500 mL and 1, 000 mL

c . b e t w e e n1 0 0 0m L a n d 1 , 5 0 0 m L d. gleaterthan 1, 500 mL

49.

AII but whichof the followingare associatedwith earlypostpartumhemorrhage? c. VaginalLacerations a. UterineAtony d. RetainedPlacentalFragments b. CervicalLacerations

50.

What is the most likelycauseof delayedpostpartumhemorrhage? c. VaginalLacerations a. UterineAtony b. CervicalLacerations d. RetainedPlacentalFraqments