Ricci Chapter 21 - Test Bank - 4th Edition

1. After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse

immediately places the woman in which position?

A. supine

B. side-lying

C. sitting

D. knee-chest

Answer: D

Rationale: Pressure on the cord needs to be relieved. Therefore, the nurse would position the

woman in a modified Sims, Trendelenburg, or knee-chest position. Supine, side-lying, or sitting

would not provide relief of cord compression.

2. A primigravida whose labor was initially progressing normally is now experiencing a decrease

in the frequency and intensity of her contractions. The nurse would assess the woman for which

condition?

A. a low-lying placenta

B. fetopelvic disproportion

C. contraction ring

D. uterine bleeding

Answer: B

Rationale: The woman is experiencing dystocia most likely due to hypotonic uterine dysfunction

and fetopelvic disproportion associated with a large fetus. A low-lying placenta, contraction ring,

or uterine bleeding would not be associated with a change in labor pattern.

3. Which assessment finding will alert the nurse to be on the lookout for possible placental

abruption during labor?

A. macrosomia

B. gestational hypertension

C. gestational diabetes

D. low parity

Answer: B

Rationale: Risk factors for placental abruption include preeclampsia, gestational hypertension,

seizure activity, uterine rupture, trauma, smoking, cocaine use, coagulation defects, previous

history of abruption, intimate partner violence, and placental pathology. Macrosomia, gestational

diabetes, and low parity are not considered risk factors.

4. A woman in labor is experiencing hypotonic uterine dysfunction. Assessment reveals no

fetopelvic disproportion. Which group of medications would the nurse expect to administer?

A. sedatives

B. tocolytics

C. uterine stimulants

D. corticosteroids

Answer: C

Rationale: For hypotonic labor, a uterine stimulant such as oxytocin may be prescribed once

fetopelvic disproportion is ruled out. Sedatives might be helpful for the woman with hypertonic

uterine contractions to promote rest and relaxation. Tocolytics would be ordered to control

preterm labor. Corticosteroids may be given to enhance fetal lung maturity for women

experiencing preterm labor.

5. A woman gave birth to a newborn via vaginal birth with the use of a vacuum extractor. The

nurse would be alert for which possible effect in the newborn?

A. asphyxia

B. clavicular fracture

C. cephalhematoma

D. central nervous system injury

Answer: C

Rationale: Use of forceps or a vacuum extractor poses the risk of tissue trauma, such as

ecchymoses, facial and scalp lacerations, facial nerve injury, cephalhematoma, and caput succedaneum. Asphyxia may be related to numerous causes, but it is not associated with use of a

vacuum extractor. Clavicular fracture is associated with shoulder dystocia. Central nervous

system injury is not associated with the use of a vacuum extractor.

6. A pregnant client undergoing labor induction is receiving an oxytocin infusion. Which finding

would require immediate intervention?

A. fetal heart rate of 150 beats/minute

B. contractions every 2 minutes, lasting 45 seconds

C. uterine resting tone of 14 mm Hg

D. urine output of 20 mL/hour

Answer: D

Rationale: Oxytocin can lead to water intoxication. Therefore, a urine output of 20 mL/hour is

below acceptable limits of 30 mL/hour and requires intervention. FHR of 150 beats/minute is

within the accepted range of 120 to 160 beats/minute. Contractions should occur every 2 to 3

minutes, lasting 40 to 60 seconds. A uterine resting tone greater than 20 mm Hg would require

intervention.

7. A woman with a history of crack cocaine use disorder is admitted to the labor and birth area.

While caring for the client, the nurse notes a sudden onset of fetal bradycardia. Inspection of the

abdomen reveals an irregular wall contour. The client also reports acute abdominal pain that is

continuous. Which condition would the nurse suspect?

A. amniotic fluid embolism

B. shoulder dystocia

C. uterine rupture

D. umbilical cord prolapse

Answer: C

Rationale: Uterine rupture is associated with crack cocaine use disorder. Generally, the first and

most reliable sign is sudden fetal distress accompanied by acute abdominal pain, vaginal

bleeding, hematuria, irregular wall contour, and loss of station in the fetal presenting part.

Amniotic fluid embolism often is manifested with a sudden onset of respiratory distress.

Shoulder dystocia is noted when continued fetal descent is obstructed after the fetal head is delivered. Umbilical cord prolapse is noted as the protrusion of the cord alongside or ahead of

the presenting part of the fetus.

8. A woman receives magnesium sulfate as treatment for preterm labor. The nurse assess and

maintains the infusion at the prescribed rate based on which finding?

A. Respiratory rate-16 breaths/minute

B. Decreased fetal heart rate variability

C. Urine output 22 mL/hour

D. Absent deep tendon reflexes

Answer: B

Rationale: A respiratory rate of 16 breaths per minute is appropriate and within acceptable

parameters to continue the infusion. When administering magnesium sulfate, the nurse would

immediately report decreaed fetal heart rate variability, a urine output less than 30 mL/hour, and

decreased or absent deep tendon reflexes.

9. The nurse is reviewing the physical examination findings for a client who is to undergo labor

induction. Which finding would indicate to the nurse that a woman's cervix is ripe in preparation

for labor induction?

A. posterior position

B. firm

C. closed

D. shortened

Answer: D

Rationale: A ripe cervix is shortened, centered (anterior), softened, and partially dilated. An

unripe cervix is long, closed, posterior, and firm.

10. A woman with preterm labor is receiving magnesium sulfate. Which finding would require

the nurse to intervene immediately?

A. respiratory rate of 16 breaths per minute

B. 1+ deep tendon reflexes

C. urine output of 45 mL/hour

D. alert level of consciousness

Answer: B

Rationale: Diminished deep tendon reflexes (1+) suggest magnesium toxicity, which requires

immediate intervention. Additional signs of magnesium toxicity include a respiratory rate less

than 12 breaths/minute, urine output less than 30 mL/hour, and a decreased level of

consciousness.

11. After teaching a couple about what to expect with their planned cesarean birth, which

statement indicates the need for additional teaching?

A. "Holding a pillow against my incision will help me when I cough."

B. "I'm going to have to wait a few days before I can start breastfeeding."

C. "I guess the nurses will be getting me up and out of bed rather quickly."

D. "I'll probably have a tube in my bladder for about 24 hours or so."

Answer: B

Rationale: Typically, breastfeeding is initiated early as soon as possible after birth to promote

bonding. The woman may need to use alternate positioning techniques to reduce incisional

discomfort. Splinting with pillows helps to reduce the discomfort associated with coughing.

Early ambulation is encouraged to prevent respiratory and cardiovascular problems and promote

peristalsis. An indwelling urinary catheter is typically inserted to drain the bladder. It usually

remains in place for approximately 24 hours.

12. When describing the stages of labor to a pregnant woman, which of the following would the

nurse identify as the major change occurring during the first stage?

A. Regular contractions

B. Cervical dilation

C. Fetal movement through the birth canal

D. Placental separation

Answer: B

Rationale: The primary change occurring during the first stage of labor is progressive cervical

dilation. Contractions occur during the first and second stages of labor. Fetal movement through

the birth canal is the major change during the second stage of labor. Placental separation occurs

during the third stage of labor.

13. The nurse is providing care to several pregnant women who may be scheduled for labor

induction. The nurse identifies the woman with which Bishop score as having the best chance for

a successful induction and vaginal birth?

A. 11

B. 7

C. 5

D. 3

Answer: A

Rationale: The Bishop score helps identify women who would be most likely to achieve a

successful induction. The duration of labor is inversely correlated with the Bishop score: a score

over 8 indicates a successful vaginal birth. Therefore the woman with a Bishop score of 11

would have the greatest chance for success. Bishop scores of

14. A nurse is reviewing the medical record of a pregnant client. The nurse suspects that the

client may be at risk for dystocia based on which factors? Select all that apply.

A. plan for pudendal block anesthetic use

B. multiparity

C. short maternal stature

D. Body mass index 30.2

E. breech fetal presentation

Answer: C, D, E

Rationale: Risk factors for dystocia may include maternal short stature, obesity, hydramnios,

uterine abnormalities, fetal malpresentation, cephalopelvic disproportion, overstimulation with

oxytocin, maternal exhaustion, ineffective pushing, excessive size fetus, poor maternal

positioning in labor, and maternal anxiety and fear

15. A nurse is preparing an inservice education program for a group of nurses about dystocia

involving problems with the passenger. Which problem would the nurse likely include as the

most common?

A. macrosomia

B. breech presentation

C. persistent occiput posterior position

D. multifetal pregnancy

Answer: C

Rationale: Common problems involving the passenger include occiput posterior position, breech

presentation, multifetal pregnancy, excessive size (macrosomia) as it relates to cephalopelvic

disproportion (CPD), and structural anomalies. Of these, persistent occiput posterior is the most

common malposition, occurring in about 15% of laboring women.

16. A nurse is conducting a review course on tocolytic therapy for perinatal nurses. After

teaching the group, the nurse determines that the teaching was successful when they identify

which drugs as being used for tocolysis? Select all that apply.

A. nifedipine

B. magnesium sulfate

C. dinoprostone

D. misoprostol

E. indomethacin

Answer: A, B, E

Rationale: Medications most commonly used for tocolysis include magnesium sulfate (which

reduces the muscle's ability to contract), indomethacin (a prostaglandin synthetase inhibitor), and

nifedipine (a calcium channel blocker). These drugs are used "off label": this means they are

effective for this purpose but have not been officially tested and developed for this purpose by

the FDA. Dinoprostone and misoprostol are used to ripen the cervix.

17. A nurse is teaching a pregnant woman at risk for preterm labor about what to do if she

experiences signs and symptoms. The nurse determines that the teaching was successful when

the woman makes which statement?

A. "I'll sit down to rest for 30 minutes."

B. "I'll try to move my bowels."

C. "I'll lie down with my legs raised."

D. "I'll drink several glasses of water."

Answer: D

Rationale: If the woman experiences any signs and symptoms of preterm labor, she should stop

what she is doing and rest for 1 hour, empty her bladder, lie down on her side, drink two to three

glasses of water, feel her abdomen and note the hardness of the contraction, and call her health

care provider and describe the contraction.

18. A nurse is describing the risks associated with post-term pregnancies as part of an inservice

presentation. The nurse determines thatmore teaching is needed when the group identifies which

factor as an underlying reason for problems in the fetus?

A. aging of the placenta

B. increased amniotic fluid volume

C. meconium aspiration

D. cord compression

Answer: B

Rationale: Fetal risks associated with a post-term pregnancy include macrosomia, shoulder

dystocia, brachial plexus injuries, low Apgar scores, postmaturity syndrome (loss of

subcutaneous fat and muscle and meconium staining), and cephalopelvic disproportion. As the

placenta ages, its perfusion decreases and it becomes less efficient at delivering oxygen and

nutrients to the fetus. Amniotic fluid volume also begins to decline after 38 weeks' gestation,

possibly leading to oligohydramnios, subsequently resulting in fetal hypoxia and an increased

risk of cord compression because the cushioning effect offered by adequate fluid is no longer

present. Hypoxia and oligohydramnios predispose the fetus to aspiration of meconium, which is

released by the fetus in response to a hypoxic insult (Norwitz, 2019). All of these issues can

compromise fetal well-being and lead to fetal distress.

19. A nurse is explaining to a group of nurses new to the labor and birth unit about methods used

for cervical ripening. The group demonstrates understanding of the information when they

identify which method as a mechanical one?

A. herbal agents

B. laminaria

C. membrane stripping

D. amniotomy

Answer: B

Rationale: Laminaria is a hygroscopic dilator that is used as a mechanical method for cervical

ripening. Herbal agents are a nonpharmacologic method. Membrane stripping and amniotomy

are considered surgical methods.

20. The nurse notifies the obstetrical team immediately because the nurse suspects that the

pregnant woman may be exhibiting signs and symptoms of amniotic fluid embolism. When

reporting this suspicion, which finding(s) would the nurse include in the report? Select all that

apply.

A. significant difficulty breathing

B. hypertension

C. tachycardia

D. pulmonary edema

E. bleeding with bruising

Answer: A, C, D, E

Rationale: Anaphylactoid syndrome of pregnancy (ASP), also known as amniotic fluid

embolism, is an unforeseeable, life-threatening complication of childbirth. The etiology of ASP

remains an enigmatic, devastating obstetric condition associated with significant maternal and

newborn morbidity and mortality. It is a rare and often fatal event characterized by the sudden

onset of hypotension, cardiopulmonary collapse, hypoxia, and coagulopathy. ASP should be

suspected in any pregnant women with an acute onset of dyspnea, hypotension, and DIC. By

knowing how to intervene, the nurse can promote a better chance of survival for both the mother

and her newborn.

21. A nurse is conducting an in-service program for a group of labor and birth unit nurses about

cesarean birth. The group demonstrates understanding of the information when they identify

which conditions as appropriate indications? Select all that apply.

A. active genital herpes infection

B. placenta previa

C. previous cesarean birth

D. prolonged labor

E. fetal distress

Answer: A, B, C, E

Rationale: The leading indications for cesarean birth are previous cesarean birth, breech

presentation, dystocia, and fetal distress. Examples of specific indications include active genital

herpes, fetal macrosomia, fetopelvic disproportion, prolapsed umbilical cord, placental

abnormality (placenta previa or placental abruption), previous classic uterine incision or scar,

gestational hypertension, diabetes, positive human immunodeficiency virus (HIV) status, and

dystocia. Fetal indications include malpresentation (nonvertex presentation), congenital

anomalies (fetal neural tube defects, hydrocephalus, abdominal wall defects), and fetal distress.

22. A pregnant woman is receiving misoprostol to ripen her cervix and induce labor. The nurse

assesses the woman closely for which effect?

A. uterine hyperstimulation

B. headache

C. blurred vision

D. hypotension

Answer: A

Rationale: A major adverse effect of the obstetric use of misoprostol is hyperstimulation of the

uterus, which may progress to uterine tetany with marked impairment of uteroplacental blood

flow, uterine rupture (requiring surgical repair, hysterectomy, and/or salpingo-oophorectomy), or

amniotic fluid embolism. Headache, blurred vision, and hypotension are associated with

magnesium sulfate.

23. A nurse is teaching a woman about measures to prevent preterm labor in future pregnancies

because the woman just experienced preterm labor with her most recent pregnancy. The nurse

determines that the teaching was successful based on which statement by the woman?

A. "I'll make sure to limit the amount of long distance traveling I do."

B. "Stress isn't a problem that is related to preterm labor."

C. "Separating pregnancies by about a year should be helpful."

D. "I'll need extra iron in my diet so I have extra for the baby."

Answer: A

Rationale: Appropriate measures to reduce the risk for preterm labor include: avoiding travel for

long distances in cars, trains, planes or buses; achieving adequate iron store through balanced

nutrition (excess iron is not necessary); waiting for at least 18 months between pregnancies, and

using stress management techniques for stress.

24. A pregnant woman at 31-weeks' gestation calls the clinic and tells the nurse that she is

having contractions sporadically. Which instructions would be most appropriate for the nurse to

give the woman? Select all that apply.

A. "Walk around the house for the next half hour."

B. "Drink two or three glasses of water."

C. "Lie down on your back."

D. "Try emptying your bladder."

E. "Stop what you are doing and rest."

Answer: B, D, E

Rationale: Appropriate instructions for the woman who may be experiencing preterm labor

include having the client stop what she is doing and rest for an hour, empty her bladder, lie down

on her left side, and drink two to three glasses of water.

25. A pregnant client has received dinoprostone. Following administration of this medication, the

nurse assesses the client and determines that the client is experiencing an adverse effect of the

medication based on which client report? Select all that apply.

A. headache

B. nausea

C. diarrhea

D. tachycardia

E. hypotension

Answer: A, B, C

Rationale: Adverse effects associated with dinoprostone include headache, nauseas and

vomiting, and diarrhea. Tachycardia and hypotension are not associated with this drug.

26. A nurse is reading a journal article about cesarean births and the indications for them. Place

the indications for cesarean birth below in the proper sequence from most frequent to least

frequent. All options must be used.

A. Labor dystocia

B. Abnormal fetal heart rate tracing

C. Fetal malpresentation

D. Multiple gestation

E. Suspected macrosomia

Answer: A, B, C, D, E

Rationale: The most common indications for primary cesarean births include, in order of

frequency: labor dystocia as the labor does not progress, abnormal fetal heart rate tracing

indicating fetal distress, fetal malpresentation making a difficult progression of labor, multiple

gestation , and suspected macrosomia.

27. A nurse is taking a history on a woman who is at 20 weeks' gestation. The woman reports

that she feels some heaviness in her thighs since yesterday. The nurse suspects that the woman

may be experiencing preterm labor based on which additional assessment findings? Select all

that apply.

A. dull low backache

B. viscous vaginal discharge

C. dysuria

D. constipation

E. occasional cramping

Answer: A, B, C

Rationale: Symptoms of preterm labor are often subtle and may include change or increase in

vaginal discharge with mucus, water, or blood in it; pelvic pressure; low, dull backache; nausea,

vomiting or diarrhea, and heaviness or aching in the thighs. Constipation is not known to be a

sign of preterm labor. Preterm labor is assessed when there are more than six contractions per

hour. Occasional asymptomatic cramping can be normal.

28. A pregnant client at 24 weeks' gestation comes to the clinic for an evaluation. The client

called the clinic earlier in the day stating that she had not felt the fetus moving since yesterday

evening. Further assessment reveals absent fetal heart tones. Intrauterine fetal demise is

suspected. The nurse would expect to prepare the client for which testing to confirm the

suspicion?

A. Ultrasound

B. Amniocentesis

C. Human chorionic gonadotropin (hCG) level

D. Triple marker screening

Answer: A

Rationale: A client experiencing an intrauterine fetal demise (IUFD) is likely to seek care when

she notices that the fetus is not moving or when she experiences contractions, loss of fluid, or

vaginal bleeding. History and physical examination frequently are of limited value in the

diagnosis of fetal death, since many times the only history tends to be recent absence of fetal

movement and no fetal heart beat heard. An inability to obtain fetal heart sounds on examination

suggests fetal demise, but an ultrasound is necessary to confirm the absence of fetal cardiac

activity. Once fetal demise is confirmed, induction of labor or expectant management is offered

to the client. An amniocentesis, hCG level, or triple marker screening would not be used to

confirm IUFD.

29. A 32-year-old black woman in her second trimester has come to the clinic for an evaluation.

While interviewing the client, she reports a history of fibroids and urinary tract infection. The

client states, "I know smoking is bad and I have tried to stop, but it is impossible. I have cut

down quite a bit though, and I do not drink alcohol." Complete blood count results reveal a low

red blood cell count, low hemoglobin, and low hematocrit. When planning this client's care, which factor(s) would the nurse identify as increasing the client's risk for preterm labor? Select

all that apply.

A. African heritage

B. Maternal age

C. History of fibroids

D. Cigarette smoking

E. History of urinary tract infections

F. Complete blood count results

Answer: A, C, D, E, F

Rationale: For this client, risk factors associated with preterm labor and birth would include

African heritage, cigarette smoking, uterine abnormalities, such as fibroids, urinary tract

infection, and possible anemia based on her complete blood count results. Maternal age extremes

(younger than 16 years and older than 35 years) are also a risk factor but do not apply to this

client.

30. A pregnant client at 30 weeks' gestation calls the clinic because she thinks that she may be in

labor. To determine if the client is experiencing labor, which question(s) would be appropriate

for the nurse to ask? Select all that apply.

A. "Are you feeling any pressure or heaviness in your pelvis?"

B. "Are you having contractions that come and go, off and on?"

C. "Have you noticed any fluid leaking from your vagina?"

D. "Are you having problems with heartburn?"

E. "Have you been having any nausea or vomiting?"

Answer: A, B, C, E

Rationale: Frequently, women are unaware that uterine contractions, effacement, and dilation are

occurring, thus making early intervention ineffective in arresting preterm labor and preventing

the birth of a premature newborn. The nurse should ask the client about any signs/symptoms,

being alert for subtle symptoms of preterm labor, which may include: a change or increase in

vaginal discharge with mucous, water, or blood in it; pelvic pressure (pushing-down sensation);

low dull backache; menstrual-like cramps; urinary tract infection symptoms; feeling of pelvic

pressure or fullness; gastrointestinal upset like nausea, vomiting, and diarrhea; general sense of

discomfort or unease; heaviness or aching in the thighs; uterine contractions with or without

pain; more than six contractions per hour; intestinal cramping with or without diarrhea.

Contractions also must be persistent, such that four contractions occur every 20 minutes or eight

contractions occur in 1 hour. A report of heartburn is unrelated to preterm labor.