Question 1

A pregnant patient is prescribed to have labor induced with oxytocin. How should the nurse prepare to administer this medication?

Accepted Answer

A)   In a 20-cc bolus of saline
B)   In two divided intramuscular sites
C)   Diluted as a "piggyback" infusion
D)   Diluted in the main intravenous fluid

Question 2

A pregnant patient receiving intravenous oxytocin for 1 hour has contractions lasting 80 seconds. What should the nurse do first for this patient?

Accepted Answer

A)   Discontinue the oxytocin infusion.
B)   Slow the infusion to below 10 gtt/minute.
C)   Increase the flow rate of the main line infusion.
D)   Continue to monitor contraction duration every 2 hours.

Question 3

The fetus of a pregnant patient is in a breech presentation. Where will the nurse auscultate fetal heart sounds?

Accepted Answer

A)   Low in the abdomen
B)   Left lateral abdomen
C)   High in the abdomen
D)   Right lateral abdomen C

Question 4

After an hour of oxytocin therapy, a patient in labor experiences headache and vomiting. What should the nurse do?

Accepted Answer

A)   Assess the vagina for full dilation.
B)   Notify the physician and stop the infusion.
C)   Instruct the patient to breathe in and out rapidly.
D)   Administer oral orange juice for added potassium.

Question 5

A patient in labor has a spinal cord injury and is unable to effectively push with contractions. Forceps will be used. What should the nurse do to prepare the patient for this type of delivery? (Select all that apply.)

Accepted Answer

A)   Provide oxygen 2 L via face mask.
B)   Validate that the cervix is fully dilated.
C)   Determine that the patient's bladder is empty.
D)   Begin an intravenous infusion of replacement fluid
E)   Ensure that the patient's membranes have ruptured. B, C, E

Question 6

The nurse is assessing a patient in labor. On which complication of labor as identified within the 2020 National Health Goals will the nurse focus?

Accepted Answer

A)   Uterine rupture
B)   Prolapsed fetal cord
C)   Hypotonic contractions
D)   Hypertonic contractions

Question 7

A patient in labor has reached 8 cm dilation, but the fetal heart rate suddenly slows. Perineal inspection reveals a prolapsed fetal cord. What should the nurse do first?

Accepted Answer

A)   Turn the patient onto the left side.
B)   Replace the cord with gentle pressure.
C)   Place the patient in a knee-chest position.
D)   Cover the exposed cord with a dry, sterile wrap.

Question 8

A pregnant patient tells the nurse that she hopes the baby is not in the breech position because she has heard that this causes difficult labor. What should the nurse include when explaining the reasons for this presentation to the patient? (Select all that apply.)

Accepted Answer

A)   Multiple fetuses
B)   Maternal diabetes
C)   Fetal birth defects
D)   Lax abdominal muscles
E)   Fetal age less than 40 weeks

Question 9

A patient in labor has been prescribed an intravenous infusion of 5% dextrose/water. Following insertion of the intravenous line, what should the nurse instruct the patient to do?

Accepted Answer

A)   Try to forget the fluid line is in place.
B)   Lie on the back to allow optimal flow.
C)   Not to get out of bed once the needle is in place.
D)   Lie perfectly still so as not to dislodge the needle.

Question 10

The nurse is caring for a patient in labor whose fetus is in an occiput posterior position. Which intervention should the nurse use to reduce this patient's discomfort?

Accepted Answer

A)   Massage the lower back.
B)   Place in a prone position.
C)   Apply ice packs to the lower back.
D)   Place in the Trendelenburg position.

Question 11

A patient is experiencing dysfunctional labor, which is prolonging the descent of the fetus. Which teaching should the nurse prepare to provide to this patient?

Accepted Answer

A)   Oxytocin therapy
B)   Fluid replacement
C)   Pain management
D)   Increasing activity

Question 12

After delivery, a patient is diagnosed with placenta succenturiata. For what procedure should the nurse prepare this patient?

Accepted Answer

A)   Lavage of the uterus
B)   Repair of an episiotomy
C)   Manual removal of accessory lobes
D)   Emergency resuscitation of the newborn

Question 13

An infant was born after a face presentation. When selecting a nursing diagnosis for the newborn, which body system does the nurse identify as a priority?

Accepted Answer

A)   Respiratory
B)   Genitourinary
C)   Cardiovascular
D)   Gastrointestinal

Question 14

While the placenta is being delivered after labor, a patient experiences an amniotic fluid embolism. What should the nurse do first to help this patient?

Accepted Answer

A)   Administer oxygen by mask.
B)   Increase intravenous fluid infusion rate.
C)   Put firm pressure on the fundus of the uterus.
D)   Tell the patient to take short, shallow breaths.

Question 15

The nurse is evaluating care provided to a patient giving birth to her first child. Which outcome regarding labor indicates that care has been effective?

Accepted Answer

A)   Client achieved 4 cm of dilation after 7 hours of labor.
B)   Client achieved full dilatation after 8 hours of labor.
C)   Client delivered infant within 2 hours after full dilatation with epidural.
D)   Client delivered infant within 30 minutes after full dilatation without epidural. A

Question 16

A pregnant patient in labor is having contractions 2 minutes apart but rarely over 50 mmHg in strength; the resting tone is high, 20 to 25 mmHg. The patient asks what can be done to make contractions more effective. What should the nurse respond to the patient?

Accepted Answer

A)   Rest because contractions are hypertonic.
B)   Receive oxytocin to strengthen contractions.
C)   Hypotonic contractions of this kind will strengthen by themselves.
D)   Walking around will make the contractions more regular.

Exam 23: Nursing Care of a Family Experiencing a Complication of Labor or Birth

A pregnant patient is prescribed to have labor induced with oxytocin. How should the nurse prepare to administer this medication?

Correct Answer
verified

A pregnant patient receiving intravenous oxytocin for 1 hour has contractions lasting 80 seconds. What should the nurse do first for this patient?

Correct Answer
verified

The fetus of a pregnant patient is in a breech presentation. Where will the nurse auscultate fetal heart sounds?

Correct Answer
verified
C

After an hour of oxytocin therapy, a patient in labor experiences headache and vomiting. What should the nurse do?

Correct Answer
verified

A patient in labor has a spinal cord injury and is unable to effectively push with contractions. Forceps will be used. What should the nurse do to prepare the patient for this type of delivery? (Select all that apply.)

Correct Answer
verified
B, C, E

The nurse is assessing a patient in labor. On which complication of labor as identified within the 2020 National Health Goals will the nurse focus?

Correct Answer
verified

A patient in labor has reached 8 cm dilation, but the fetal heart rate suddenly slows. Perineal inspection reveals a prolapsed fetal cord. What should the nurse do first?

Correct Answer
verified

A pregnant patient tells the nurse that she hopes the baby is not in the breech position because she has heard that this causes difficult labor. What should the nurse include when explaining the reasons for this presentation to the patient? (Select all that apply.)

Correct Answer
verified

A patient in labor has been prescribed an intravenous infusion of 5% dextrose/water. Following insertion of the intravenous line, what should the nurse instruct the patient to do?

Correct Answer
verified

The nurse is caring for a patient in labor whose fetus is in an occiput posterior position. Which intervention should the nurse use to reduce this patient's discomfort?

Correct Answer
verified

A patient is experiencing dysfunctional labor, which is prolonging the descent of the fetus. Which teaching should the nurse prepare to provide to this patient?

Correct Answer
verified

After delivery, a patient is diagnosed with placenta succenturiata. For what procedure should the nurse prepare this patient?

Correct Answer
verified

An infant was born after a face presentation. When selecting a nursing diagnosis for the newborn, which body system does the nurse identify as a priority?

Correct Answer
verified

While the placenta is being delivered after labor, a patient experiences an amniotic fluid embolism. What should the nurse do first to help this patient?

Correct Answer
verified

The nurse is evaluating care provided to a patient giving birth to her first child. Which outcome regarding labor indicates that care has been effective?

Correct Answer
verified
A

A pregnant patient in labor is having contractions 2 minutes apart but rarely over 50 mmHg in strength; the resting tone is high, 20 to 25 mmHg. The patient asks what can be done to make contractions more effective. What should the nurse respond to the patient?

Correct Answer
verified

Exam 23: Nursing Care of a Family Experiencing a Complication of Labor or Birth

A pregnant patient is prescribed to have labor induced with oxytocin. How should the nurse prepare to administer this medication?

Correct AnswerverifiedShow Answer

A pregnant patient receiving intravenous oxytocin for 1 hour has contractions lasting 80 seconds. What should the nurse do first for this patient?

Correct AnswerverifiedShow Answer

The fetus of a pregnant patient is in a breech presentation. Where will the nurse auscultate fetal heart sounds?

Correct AnswerverifiedC

After an hour of oxytocin therapy, a patient in labor experiences headache and vomiting. What should the nurse do?

Correct AnswerverifiedShow Answer

A patient in labor has a spinal cord injury and is unable to effectively push with contractions. Forceps will be used. What should the nurse do to prepare the patient for this type of delivery? (Select all that apply.)

Correct AnswerverifiedB, C, E

The nurse is assessing a patient in labor. On which complication of labor as identified within the 2020 National Health Goals will the nurse focus?

Correct AnswerverifiedShow Answer

A patient in labor has reached 8 cm dilation, but the fetal heart rate suddenly slows. Perineal inspection reveals a prolapsed fetal cord. What should the nurse do first?

Correct AnswerverifiedShow Answer

A pregnant patient tells the nurse that she hopes the baby is not in the breech position because she has heard that this causes difficult labor. What should the nurse include when explaining the reasons for this presentation to the patient? (Select all that apply.)

Correct AnswerverifiedShow Answer

A patient in labor has been prescribed an intravenous infusion of 5% dextrose/water. Following insertion of the intravenous line, what should the nurse instruct the patient to do?

Correct AnswerverifiedShow Answer

The nurse is caring for a patient in labor whose fetus is in an occiput posterior position. Which intervention should the nurse use to reduce this patient's discomfort?

Correct AnswerverifiedShow Answer

A patient is experiencing dysfunctional labor, which is prolonging the descent of the fetus. Which teaching should the nurse prepare to provide to this patient?

Correct AnswerverifiedShow Answer

After delivery, a patient is diagnosed with placenta succenturiata. For what procedure should the nurse prepare this patient?

Correct AnswerverifiedShow Answer

An infant was born after a face presentation. When selecting a nursing diagnosis for the newborn, which body system does the nurse identify as a priority?

Correct AnswerverifiedShow Answer

While the placenta is being delivered after labor, a patient experiences an amniotic fluid embolism. What should the nurse do first to help this patient?

Correct AnswerverifiedShow Answer

The nurse is evaluating care provided to a patient giving birth to her first child. Which outcome regarding labor indicates that care has been effective?

Correct AnswerverifiedA

A pregnant patient in labor is having contractions 2 minutes apart but rarely over 50 mmHg in strength; the resting tone is high, 20 to 25 mmHg. The patient asks what can be done to make contractions more effective. What should the nurse respond to the patient?

Correct AnswerverifiedShow Answer

Correct Answer
verified

Correct Answer
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Correct Answer
verified
C

Correct Answer
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Correct Answer
verified
B, C, E

Correct Answer
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Correct Answer
verified

Correct Answer
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Correct Answer
verified

Correct Answer
verified

Correct Answer
verified

Correct Answer
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Correct Answer
verified

Correct Answer
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Correct Answer
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A

Correct Answer
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