ATI Maternal Newborn Test 3 Exam Study Guide

Chapter 19: Processes and Stages of Labor and Birth 1) How would the nurse best analyze the results from a client's sonogram that shows the fetal shoulder as the presenting part? A) Breech, transverse B) Breech, longitudinal C) Breech, frank D) Vertex, transverse Explanation: A) A shoulder presentation is one type of breech presentation, and is also called a transverse lie. 2) A clinic nurse is preparing diagrams of pelvic shapes. Which pelvic shapes are considered least adequate for vaginal childbirth? Select all that apply. A) Android B) Anthropoid C) Gynecoid D) Platypelloid E) Lambdoidal suture Explanation: A) In the android and platypelloid types, the pelvic diameters are diminished. Labor is more likely to be difficult (longer) and a cesarean birth is more likely. D) In the android and platypelloid types, the pelvic diameters are diminished. Labor is more likely to be difficult (longer) and a cesarean birth is more likely. 3) The nurse is caring for laboring clients. Which women are experiencing problems related to a critical factor of labor? Select all that apply. A) Woman at 7 cm, fetus in general flexion B) Woman at 3 cm, fetus in longitudinal lie C) Woman at 4 cm, fetus with transverse lie D) Woman at 6 cm, fetus at -2 station, mild contractions E) Woman at 5 cm, fetal presenting part is right shoulder Explanation: C) A transverse lie occurs when the cephalocaudal axis of the fetal spine is at a right angle to the woman's spine and is associated with a shoulder presentation and can lead to complications in the later stages of labor. D) Station refers to the relationship of the presenting part to an imaginary line drawn between the ischial spines of the maternal pelvis. If the presenting part is higher than the ischial spines, a negative number is assigned, noting centimeters above zero station. A -2 station is high in the pelvis. Contractions should be strong to cause fetal descent. Mild contractions will not move the baby down or open the cervix. This client is experiencing a problem between the maternal pelvis and the presenting part. E) When the fetal shoulder is the presenting part, the fetus is in a transverse lie and the acromion process of the scapula is the landmark. This type of presentation occurs less than 1% of the time. This client is experiencing a problem between the maternal pelvis and the presenting part. 4) The charge nurse has received the shift change report. Which client requires immediate intervention? A) Woman at 6 cm undergoing induction of labor, strong contractions every 3 minutes B) Woman at 4 cm whose fetus is in a longitudinal lie with a cephalic presentation C) Woman at 10 cm and fetus at +2 station experiencing a strong expulsion urge D) Woman at 3 cm screaming in fear because her mother died during childbirth Explanation: D) This client is most likely fearful that she will die during labor because her mother died during childbirth. This client requires education and a great deal of support, and is therefore the top priority. 5) Premonitory signs of labor include which of the following? Select all that apply. A) Braxton Hicks contractions B) Cervical softening and effacement C) Weight gain D) Rupture of membranes E) Sudden loss of energy Explanation: A) A premonitory sign of labor includes Braxton Hicks contractions. B) A premonitory sign of labor includes cervical softening and effacement. D) A premonitory sign of labor includes rupture of membranes. 6) A client arrives in the labor and delivery unit and describes her contractions as occurring every 10-12 minutes, lasting 30 seconds. She is smiling and very excited about the possibility of being in labor. On exam, her cervix is dilated 2 cm, 100% effaced, and -2 station. What best describes this labor? A) Second phase B) Latent phase C) Active phase D) Transition phase Explanation: B) In the early or latent phase of the first stage of labor, contractions are usually mild. The woman feels able to cope with the discomfort. The woman is often talkative and smiling and is eager to talk about herself and answer questions. 7) The client has asked the nurse why her cervix has only changed from 1 to 2 cm in 3 hours of contractions occurring every 5 minutes. What is the nurse's best response to the client? A) "Your cervix has also effaced, or thinned out, and that change in the cervix is also labor progress." B) "When your perineal body thins out, your cervix will begin to dilate much faster than it is now." C) "What did you expect? You've only had contractions for a few hours. Labor takes time." D) "The hormones that cause labor to begin are just getting to be at levels that will change your cervix." Explanation: A) With each contraction, the muscles of the upper uterine segment shorten and exert a longitudinal traction on the cervix, causing effacement. Effacement is the taking up (or drawing up) of the internal os and the cervical canal into the uterine side walls. 8) To identify the duration of a contraction, the nurse would do which of the following? A) Start timing from the beginning of one contraction to the completion of the same contraction. B) Time between the beginning of one contraction and the beginning of the next contraction. C) Palpate for the strength of the contraction at its peak. D) Time from the beginning of the contraction to the peak of the same contraction. Explanation: A) The duration of each contraction is measured from the beginning of the contraction to the completion of the contraction. 9) The client at 40 weeks' gestation reports to the nurse that she has had increased pelvic pressure and increased urinary frequency. Which response by the nurse is best? A) "Unless you have pain with urination, we don't need to worry about it." B) "These symptoms usually mean the baby's head has descended further." C) "Come in for an appointment today and we'll check everything out." D) "This might indicate that the baby is no longer in a head-down position." Explanation: B) This is the best response because it most directly addresses what the client has reported. 10) The client at 39 weeks' gestation calls the clinic and reports increased bladder pressure but easier breathing and irregular, mild contractions. She also states that she just cleaned the entire house. Which statement should the nurse make? A) "You shouldn't work so much at this point in pregnancy." B) "What you are describing is not commonly experienced in the last weeks." C) "Your body may be telling you it is going into labor soon." D) "If the bladder pressure continues, come in to the clinic tomorrow." Explanation: C) One of the premonitory signs of labor is lightening: The fetus begins to settle into the pelvic inlet (engagement). With fetal descent, the uterus moves downward, and the fundus no longer presses on the diaphragm, which eases breathing. 11) A client calls the labor and delivery unit and tells the nurse that she is 39 weeks pregnant and over the last 4 or 5 days, she has noticed that although her breathing has become easier, she is having leg cramps, a slight amount of edema in her lower legs, and an increased amount of vaginal secretions. The nurse tells the client that she has experienced which of the following? A) Engagement B) Lightening C) Molding D) Braxton Hicks contractions Explanation: B) Lightening describes the effect occurring when the fetus begins to settle into the pelvic inlet. 12) A client who is having false labor most likely would have which of the following? Select all that apply. A) Contractions that do not intensify while walking B) An increase in the intensity and frequency of contractions C) Progressive cervical effacement and dilation D) Pain in the abdomen that does not radiate E) Contractions that lessen with rest and warm tub baths Explanation: A) True labor contractions intensify while walking. D) True labor results in progressive dilation, increased intensity and frequency of contractions, and pain in the back that radiates to the abdomen. E) In true labor, contractions do not lessen with rest and warm tub baths. 13) The nurse is preparing a client education handout on the differences between false labor and true labor. What information is most important for the nurse to include? A) True labor contractions begin in the back and sweep toward the front. B) False labor often feels like abdominal tightening, or "balling up." C) True labor can be diagnosed only if cervical change occurs. D) False labor contractions do not increase in intensity or duration. Explanation: C) Cervical change is the only factor that actually distinguishes false from true labor. The contractions of true labor produce progressive dilation and effacement of the cervix. The contractions of false labor do not produce progressive cervical effacement and dilation. 14) The nurse is teaching a prenatal class about false labor. The nurse should teach clients that false labor will most likely include which of the following? Select all that apply. A) Contractions that do not intensify while walking B) An increase in the intensity and frequency of contractions C) Progressive cervical effacement and dilation D) Pain in the abdomen that does not radiate E) Contractions are at regular intervals Explanation: A) True labor contractions intensify while walking. D) The discomfort of true labor contractions usually starts in the back and radiates around to the abdomen. 15) A client is admitted to the labor and delivery unit with contractions that are 2 minutes apart, lasting 60 seconds. She reports that she had bloody show earlier that morning. A vaginal exam reveals that her cervix is 100 percent effaced and 8 cm dilated. The nurse knows that the client is in which phase of labor? A) Active B) Latent C) Transition D) Fourth Explanation: C) The transition phase begins with 8 cm to 10 cm of dilation, and contractions become more frequent, are longer in duration, and increase in intensity. 16) A client is admitted to the labor unit with contractions 1-2 minutes apart lasting 60-90 seconds. The client is apprehensive and irritable. This client is most likely in what phase of labor? A) Active B) Transition C) Latent D) Second Explanation: B) During transition, contractions have a frequency of 1 1/2 to 2 minutes, a duration of 60 to 90 seconds, and are strong in intensity. When the woman enters the transition phase, she may demonstrate significant anxiety. 17) The client in early labor asks the nurse what the contractions are like as labor progresses. What would the nurse respond? A) "In normal labor, as the uterine contractions become stronger, they usually also become less frequent." B) "In normal labor, as the uterine contractions become stronger, they usually also become less painful." C) "In normal labor, as the uterine contractions become stronger, they usually also become longer in duration." D) "In normal labor, as the uterine contractions become stronger, they usually also become shorter in duration." Explanation: C) During the active and transition phases, contractions become more frequent, are longer in duration, and increase in intensity. 18) Four minutes after the birth of a baby, there is a sudden gush of blood from the mother's vagina, and about 8 inches of umbilical cord slides out. What action should the nurse take first? A) Place the client in McRoberts position. B) Watch for the emergence of the placenta. C) Prepare for the delivery of an undiagnosed twin. D) Place the client in a supine position. Explanation: B) Signs of placental separation usually appear around 5 minutes after birth of the infant, but can take up to 30 minutes to manifest. These signs are (1) a globular-shaped uterus, (2) a rise of the fundus in the abdomen, (3) a sudden gush or trickle of blood, and (4) further protrusion of the umbilical cord out of the vagina. 19) A nurse needs to evaluate the progress of a woman's labor. The nurse obtains the following data: cervical dilation 6 cm; contractions mild in intensity, occurring every 5 minutes, with a duration of 30-40 seconds. Which clue in this data does not fit the pattern suggested by the rest of the clues? A) Cervical dilation 6 cm B) Mild contraction intensity C) Contraction frequency every 5 minutes D) Contraction duration 30-40 seconds Explanation: A) Cervical dilation of 6 cm indicates the active phase of labor. During this phase the cervix dilates from about 4 to 7 cm and contractions and pain intensify. 20) The labor nurse would not encourage a mother to bear down until the cervix is completely dilated, to prevent which of the following? Select all that apply. A) Maternal exhaustion B) Cervical edema C) Tearing and bruising of the cervix D) Enhanced perineal thinning E) Having to perform an episiotomy Explanation: A) If the cervix is not completely dilated, maternal exhaustion can occur. B) If the cervix is not completely dilated, cervical edema can occur. C) If the cervix is not completely dilated, tearing and bruising of the cervix can occur. 21) The nurse is caring for a laboring client. A cervical exam indicates 8 cm dilation. The client is restless, frequently changing position in an attempt to get comfortable. Which nursing action is most important? A) Leave the client alone so she can rest. B) Ask the family to take a coffee-and-snack break. C) Encourage the client to have an epidural for pain. D) Reassure the client that she will not be left alone. Explanation: D) Because the client is in the transitional phase of the first stage of labor, she will not want to be left alone; staying with the client and reassuring her that she will not be alone are the highest priorities at this time. 22) During the fourth stage of labor, the client's assessment includes a BP of 110/60, pulse 90, and the fundus is firm midline and halfway between the symphysis pubis and the umbilicus. What is the priority action of the nurse? A) Turn the client onto her left side. B) Place the bed in Trendelenburg position. C) Massage the fundus. D) Continue to monitor. Explanation: D) The client's assessment data are normal for the fourth stage of labor, so monitoring is the only action necessary. During the fourth stage of labor, the mother experiences a moderate drop in both systolic and diastolic blood pressure, increased pulse pressure, and moderate tachycardia. 23) The nurse has just palpated a laboring woman's contractions. The uterus cannot be indented during a contraction. What would the intensity of these contractions best be characterized as? A) Weak B) Mild C) Moderate D) Strong Explanation: D) Strong intensity exists when the uterine wall cannot be indented. 24) The labor and delivery nurse is reviewing charts. The nurse should inform the supervisor about which client? A) Client at 5 cm requesting labor epidural analgesia B) Client whose cervix remains at 6 cm for 4 hours C) Client who has developed nausea and vomiting D) Client requesting her partner to stay with her Explanation: B) Average cervical change in the active phase of the first stage of labor is 1.2 cm/hour; thus, this client's lack of cervical change is unexpected, and should be reported to the supervisor. 25) Which client requires immediate intervention by the labor and delivery nurse? A) Client at 8 cm, systolic blood pressure has increased 35 mmHg B) Client who delivered 1 hour ago with WBC of 50,000/mm3 C) Client at 5 cm with a respiratory rate of 22 between contractions D) Client in active labor with polyuria Explanation: B) The white blood cell (WBC) count increases to between 25,000/mm3 to 30,000/mm3 during labor and early postpartum. This count is abnormally high, and requires further assessment and provider notification. 26) The labor and delivery nurse is preparing a prenatal class about facilitating the progress of labor. Which of the following frequent responses to pain should the nurse indicate is most likely to impede progress in labor? A) Increased pulse B) Elevated blood pressure C) Muscle tension D) Increased respirations Explanation: C) It is important for the woman to relax each part of her body. Be alert for signs of muscle tension and tightening. Dissociative relaxation, controlled muscle relaxation, and specified breathing patterns are used to promote birth as a normal process. 27) While caring for a client in labor, the nurse notices during a vaginal exam that the fetus's head has rotated internally. What would the nurse expect the next set of cardinal movements for a fetus in a vertex presentation to be? A) Flexion, extension, restitution, external rotation, and expulsion B) Expulsion, external rotation, and restitution C) Restitution, flexion, external rotation, and expulsion D) Extension, restitution, external rotation, and expulsion Explanation: D) The fetus changes position in the following order: descent, flexion, internal rotation, extension, restitution, external rotation, and expulsion. 28) When comparing the anterior and posterior fontanelles of a newborn, the nurse knows that both are what? A) Both are approximately the same size. B) Both close within 12 months of birth. C) Both are used in labor to identify station. D) Both allow for assessing the status of the newborn after birth. Explanation: D) The anterior and posterior fontanelles are clinically useful in identifying the position of the fetal head in the pelvis and in assessing the status of the newborn after birth. 29) The nurse is aware that labor and birth will most likely proceed normally when the fetus is in what position? A) Right-acromion-dorsal-anterior B) Right-sacrum-transverse C) Occiput anterior D) Posterior position Explanation: C) The most common fetal position is occiput anterior. When this position occurs, labor and birth are likely to proceed normally. 30) The midwife performs a vaginal exam and determines that the fetal head is at a -2 station. What does this indicate to the nurse about the birth? A) The birth is imminent. B) The birth is likely to occur in 1-2 hours. C) The birth will occur later in the shift. D) The birth is difficult to predict. Explanation: D) A -2 station means that the fetus is 2 cm above the ischial spines. The ischial spines as a landmark have been designated as zero station. If the presenting part is higher than the ischial spines, a negative number is assigned, noting centimeters above zero station. With the fetus's head that high in the pelvis, it is difficult to predict when birth will occur. 31) Childbirth preparation offers several advantages including which of the following? Select all that apply. A) It helps a pregnant woman and her support person understand the choices in the birth setting. B) It promotes awareness of available options. C) It provides tools for a pregnant woman and her support person to use during labor and birth. D) Women who receive continuous support during labor require more analgesia, and have more cesarean and instrument births. E) Each method has been shown to shorten labor. Explanation: A) Childbirth preparation offers several advantages. It helps a pregnant woman and her support person understand the choices in the birth setting, promotes awareness of available options, and provides tools for them to use during labor and birth. B) Childbirth preparation offers several advantages. It helps a pregnant woman and her support person understand the choices in the birth setting, promotes awareness of available options, and provides tools for them to use during labor and birth. C) Childbirth preparation offers several advantages. It helps a pregnant woman and her support person understand the choices in the birth setting, promotes awareness of available options, and provides tools for them to use during labor and birth. E) Childbirth preparation offers several advantages. Each method has been shown to shorten labor. C) 33) The fetus of a patient in labor is determined to be in the brow presentation. Which diagram should the nurse provide to the patient to explain this position? A) B) D) A) Explanation: C) In the brow presentation, the fetal head is in partial (halfway) extension. The occipitomental diameter, which is the largest diameter of the fetal head, presents to the pelvis. Choice 1 is the vertex presentation. Complete flexion of the head allows the suboccipitobregmatic diameter to present to the pelvis. Choice 2 is the Sinciput (median vertex) presentation (also called military presentation) with no flexion or extension. The occipitofrontal diameter presents to the pelvis. Choice 4 is the face presentation. The fetal head is in complete extension, and the submentobregmatic diameter presents to the pelvis. 34) A pregnant patient's fetus is in the left-occiput-transverse position. Which diagram should the nurse use to explain this position to the patient? B) C) D) Explanation: A) Choice 1 is the LOT or left-occiput-transverse position. Choice 2 is the LOP or left-occiputposterior position. Choice 3 is the ROT or right-occiput-transverse position. Choice 4 is the LOA or leftocciput-anterior position. Chapter 21: The Family in Childbirth: Needs and Care 1) The laboring client is at 7 cm, with the vertex at a +1 station. Her birth plan indicates that she and her partner took Lamaze prenatal classes, and they have planned on a natural, unmedicated birth. Her contractions are every 3 minutes and last 60 seconds. She has used relaxation and breathing techniques very successfully in her labor until the last 15 minutes. Now, during contractions, she is writhing on the bed and screaming. Her labor partner is rubbing the client's back and speaking to her quietly. Which nursing diagnosis should the nurse incorporate into the plan of care for this client? A) Fear/Anxiety related to discomfort of labor and unknown labor outcome B) Pain, Acute, related to uterine contractions, cervical dilatation, and fetal descent C) Coping: Family, Compromised, related to labor process D) Knowledge, Deficient, related to lack of information about normal labor process and comfort measures Explanation: B) The client is exhibiting signs of acute pain, which is both common and expected in the transitional phase of labor. 2) A client is admitted to the labor and delivery unit with contractions that are regular, are 2 minutes apart, and last 60 seconds. She reports that her labor began about 6 hours ago, and she had bloody show earlier that morning. A vaginal exam reveals a vertex presenting, with the cervix 100% effaced and 8 cm dilated. The client asks what part of labor she is in. The nurse should inform the client that she is in what phase of labor? A) Latent phase B) Active phase C) Transition phase D) Fourth stage Explanation: C) The transition phase begins with 8 cm of dilatation, and is characterized by contractions that are closer and more intense. 3) The nurse is assessing the comfort of the parents during the third stage of labor. Which finding(s) indicate that the parents feel comfortable during this stage? Select all that apply. A) Talking to the newborn B) Verbally expressing feelings of pride C) Requesting to dim the lights D) Preferring limited contact with the newborn initially E) Immediately placing phone calls Explanation: A) Talking to the newborn and verbally expressing feelings of pride are indications that the parents feel comfortable in the environment. B) Talking to the newborn and verbally expressing feelings of pride are indications that the parents feel comfortable in the environment. 4) The nurse is caring for a client and her spouse during the third stage of labor. Which action(s) support initial parental-newborn attachment at this time? Select all that apply. A) Minimizing assessments B) Delaying ophthalmic antibiotics for 2 hours C) Dimming the room lights D) Talking quietly E) Providing privacy Explanation: A) Minimizing assessments enhances parental newborn attachment during this time. C) Dimming the room lights enhances parental-newborn attachment during this time. D) Talking quietly enhances parental-newborn attachment during this time. E) Providing privacy enhances parental-newborn attachment during this time. 5) The nurse is assessing the emotional state of a client following the delivery of her newborn. Which response by the client requires further follow up by the nurse? A) Excitability B) Crying C) Quiet D) Withdrawn Explanation: D) Being withdrawn is not considered a normal emotional response to delivery of a newborn, and requires further follow up by the nurse. 6) The client presents to the labor and delivery unit stating that her water broke 2 hours ago. Indicators of normal labor include which of the following? Select all that apply. A) Fetal heart rate of 130 with average variability B) Blood pressure of 130/80 C) Maternal pulse of 160 D) Protein of +1 in urine E) Odorless, clear fluid on underwear Explanation: A) Fetal heart rate (FHR) of 110-160 with average variability is a normal indication. B) Maternal vital sign of blood pressure below 140/90 is a normal indication. E) Fluid clear and without odor if membranes ruptured is a normal indication. 7) The client is being admitted to the birthing unit. As the nurse begins the assessment, the client's partner asks why the fetus's heart rate will be monitored. After the nurse explains, which statement by the partner indicates a need for further teaching? A) "The fetus's heart rate will vary between 110 and 160." B) "The heart rate is monitored to see whether the fetus is tolerating labor." C) "By listening to the heart, we can tell the gender of the fetus." D) "After listening to the heart rate, you will contact the midwife." Explanation: C) Fetal heart rate is not a predictor of gender. 8) The laboring client and her partner have arrived at the birthing unit. Which step of the admission process should be undertaken first? A) The sterile vaginal exam B) Welcoming the couple C) Auscultation of the fetal heart rate D) Checking for ruptured membranes Explanation: B) It is important to establish rapport and to create an environment in which the family feels free to ask questions. The support and encouragement of the nurse in maintaining a caring environment begins with the initial admission. 9) An expectant father has been at the bedside of his laboring partner for more than 12 hours. An appropriate nursing intervention would be which of the following? A) Insist that he leave the room for at least the next hour. B) Tell him he is not being as effective as he was, and that he needs to let someone else take over. C) Offer to remain with his partner while he takes a break. D) Suggest that the client's mother might be of more help. Explanation: C) Support persons frequently are reluctant to leave the laboring woman to take care of their own needs. The laboring woman often fears being alone during labor. Even though there is a support person available, the woman's anxiety may be decreased when the nurse remains with her while he takes a break. 10) By inquiring about the expectations and plans that a laboring woman and her partner have for the labor and birth, the nurse is primarily doing which of the following? A) Recognizing the client as an active participant in her own care. B) Attempting to correct any misinformation the client might have received. C) Acting as an advocate for the client. D) Establishing rapport with the client. Explanation: A) Understanding the couple's expectations and plans helps the nurse provide optimal nursing care and facilitate the best possible birth experience. 11) The labor and birth nurse is admitting a client. The nurse's assessment includes asking the client whom she would like to have present for the labor and birth, and what the client would prefer to wear. The client's partner asks the nurse the reason for these questions. What would the nurse's best response be? Select all that apply. A) "These questions are asked of all women. It's no big deal." B) "I'd prefer that your partner ask me all the questions, not you." C) "A client's preferences for her birth are important for me to understand." D) "Many women have beliefs about childbearing that affect these choices." E) "I'm gathering information that the nurses will use after the birth." Explanation: C) The nurse incorporates the family's expectations into the plan of care to be culturally appropriate and to facilitate the birth. D) The nurse incorporates the family's expectations into the plan of care to be culturally appropriate and to facilitate the birth. 12) The laboring client presses the call light and reports that her water has just broken. What would the nurse's first action be? A) Check fetal heart tones. B) Encourage the mother to go for a walk. C) Change bed linens. D) Call the physician. Explanation: A) When the membranes rupture, the nurse notes the color and odor of the amniotic fluid and the time of rupture and immediately auscultates the FHR. 13) The laboring client is having moderately strong contractions lasting 60 seconds every 3 minutes. The fetal head is presenting at a -2 station. The cervix is 6 cm and 100% effaced. The membranes spontaneously ruptured prior to admission, and clear fluid is leaking. Fetal heart tones are in the 140s with accelerations to 150. Which nursing action has the highest priority? A) Encourage the husband to remain in the room. B) Keep the client on bed rest at this time. C) Apply an internal fetal scalp electrode. D) Obtain a clean-catch urine specimen. Explanation: B) Because the membranes are ruptured and the head is high in the pelvis at a -2 station, the client should be maintained on bed rest to prevent cord prolapse. 14) The client has stated that she wants to avoid an epidural and would like an unmedicated birth. Which nursing action is most important for this client? A) Encourage the client to vocalize during contractions. B) Perform vaginal exams only between contractions. C) Provide a CD of soft music with sounds of nature. D) Offer to teach the partner how to massage tense muscles. Explanation: D) Massage is helpful for many clients, especially during latent and active labor. Massage can increase relaxation and therefore decrease tension and pain. 15) The nurse is reviewing the contents of the birthing unit's emergency pack for use in case of a precipitous birth. Which item(s) should the nurse ensure is (are) included in the pack? Select all that apply. A) Sterile drape B) Bulb syringe C) Two sterile clamps D) Sterile gloves E) Forceps Explanation: A) A small drape is included that can be placed under the woman's buttocks to provide a sterile field. B) A bulb syringe is needed to clear mucus from the newborn's mouth. C) Two sterile clamps (Kelly or Rochester) are needed to clamp the umbilical cord before applying a cord clamp. D) Sterile gloves are a basic element of a typical birthing unit emergency pack. 16) Two hours after delivery, a client's fundus is boggy and has risen to above the umbilicus. What is the first action the nurse would take? A) Massage the fundus until firm B) Express retained clots C) Increase the intravenous solution D) Call the physician Explanation: A) When the uterus becomes boggy, pooling of blood occurs within it, resulting in the formation of clots. Anything left in the uterus prevents it from contracting effectively. Thus if it becomes boggy or appears to rise in the abdomen, the fundus should be massaged until firm. 17) Why is it important for the nurse to assess the bladder regularly and encourage the laboring client to void frequently? A) A full bladder impedes oxygen flow to the fetus B) Frequent voiding prevents bruising of the bladder. C) Frequent voiding encourages sphincter control. D) A full bladder can impede fetal descent. Explanation: D) The woman should be encouraged to void because a full bladder can interfere with fetal descent. If the woman is unable to void, catheterization may be necessary. 18) The laboring client is complaining of tingling and numbness in her fingers and toes, dizziness, and spots before her eyes. The nurse recognizes that these are clinical manifestations of which of the following? A) Hyperventilation B) Seizure auras C) Imminent birth D) Anxiety Explanation: A) These symptoms all are consistent with hyperventilation. 19) A client who wishes to have an unmedicated birth is in the transition stage. She is very uncomfortable and turns frequently in the bed. Her partner has stepped out momentarily. How can the nurse be most helpful? A) Talk to the client the entire time. B) Turn on the television to distract the client. C) Stand next to the bed with hands on the railing next to the client. D) Sit silently in the room away from the bed. Explanation: C) Standing next to the bed is supportive without being irritating. The laboring woman fears being alone during labor. The woman's anxiety may be decreased when the nurse remains with her. 20) The nurse administered oxytocin 20 units at the time of placental delivery. Why was this primarily done? A) To contract the uterus and minimize bleeding B) To decrease breast milk production C) To decrease maternal blood pressure D) To increase maternal blood pressure Explanation: A) Oxytocin is given to contract the uterus and minimize bleeding. 21) A client delivered 30 minutes ago. Which postpartal assessment finding would require close nursing attention? A) A soaked perineal pad since the last 15-minute check B) An edematous perineum C) The client experiencing tremors D) A fundus located at the umbilicus Explanation: A) If the perineal pad becomes soaked in a 15-minute period, or if blood pools under the buttocks, continuous observation is necessary. As long as the woman remains in bed during the first hour, bleeding should not exceed saturation of one pad. 22) The neonate was born 5 minutes ago. The body is bluish. The heart rate is 150. The infant is crying strongly. The infant cries when the sole of the foot is stimulated. The arms and legs are flexed, and resist straightening. What should the nurse record as this infant's Apgar score? A) 7 B) 8 C) 9 D) 10 Explanation: B) The strong cry earns 2 points. The crying with foot sole stimulation earns 2 points. The limb flexion and resistance earn 2 points each. Bluish color earns 0 points. The Apgar score is 8. 23) Before applying a cord clamp, the nurse assesses the umbilical cord. The mother asks why the nurse is doing this. What should the nurse reply? A) "I'm checking the blood vessels in the cord to see whether it has one artery and one vein." B) "I'm checking the blood vessels in the cord to see whether it has two arteries and one vein." C) "I'm checking the blood vessels in the cord to see whether it has two veins and one artery." D) "I'm checking the blood vessels in the cord to see whether it has two arteries and two veins." Explanation: B) Two arteries and one vein are present in a normal umbilical cord. 24) At 1 minute after birth, the infant has a heart rate of 100 beats per minute, and is crying vigorously. The limbs are flexed, the trunk is pink, and the feet and hands are cyanotic. The infant cries easily when the soles of the feet are stimulated. How would the nurse document this infant's Apgar score? A) 7 B) 8 C) 9 D) 10 Explanation: C) Two points each are scored in each of the categories of heart rate, respiratory effort, muscle tone, and reflex irritability. One point is scored in the category of skin color. The total Apgar would be 9. 25) Upon delivery of the newborn, what nursing intervention most promotes parental attachment? A) Placing the newborn under the radiant warmer. B) Placing the newborn on the mother's abdomen. C) Allowing the mother a chance to rest immediately after delivery. D) Taking the newborn to the nursery for the initial assessment. Explanation: B) As the baby is placed on the mother's abdomen or chest, she frequently reaches out to touch and stroke her baby. When the newborn is placed in this position, the father or partner also has a very clear, close view and can reach out to touch the baby. 26) A young adolescent is transferred to the labor and delivery unit from the emergency department. The client is in active labor, but did not know she was pregnant. What is the most important nursing action? A) Determine who might be the father of the baby for paternity testing. B) Ask the client what kind of birthing experience she would like to have. C) Assess blood pressure and check for proteinuria. D) Obtain a Social Services referral to discuss adoption. Explanation: C) Preeclampsia is more common among adolescents than in young adults, and is potentially life-threatening to both mother and fetus. This assessment is the highest priority. 27) As compared with admission considerations for an adult woman in labor, the nurse's priority for an adolescent in labor would be which of the following? A) Cultural background B) Plans for keeping the infant C) Support persons D) Developmental level Explanation: D) Because her cognitive development is incomplete, the younger adolescent may have fewer problem-solving capabilities. The very young woman needs someone to rely on at all times during labor. She may be more childlike and dependent than older teens. 28) An abbreviated systematic physical assessment of the newborn is performed by the nurse in the birthing area to detect any abnormalities. Normal findings would include which of the following? Select all that apply. A) Skin color: Body blue with pinkish extremities B) Umbilical cord: two veins and one artery C) Respiration rate of 30-60 irregular D) Temperature of above 36.5°C (97.8°F) E) Sole creases that involve the heel Explanation: C) Normal findings would include a respiration rate of 30-60 irregular. D) Normal findings would include temperature of above 36.5°C (97.8°F). E) Normal findings would include sole creases that involve the heel. 29) A client's labor has progressed so rapidly that a precipitous birth is occurring. What should the nurse do? A) Go to the nurse's station and immediately call the physician. B) Run to the delivery room for an emergency birth pack. C) Stay with the client and ask auxiliary personnel for assistance. D) Hold back the infant's head forcibly until the physician arrives for the delivery. Explanation: C) If birth is imminent, the nurse must not leave the client alone. 30) The nurse has completed an initial physical assessment for a client admitted to the birthing unit. Which action should the nurse take next? A) Obtain the client's social history B) Document the physical assessment findings C) Report findings to the physician D) Perform interventions for pain management Explanation: A) Once initial physical assessments are performed, the nurse can then take a detailed social history that provides a comprehensive view of both the woman's social habits and psychologic factors that may affect her birth experience. 31) The nurse has taken a detailed social history from a client admitted to the birthing unit. Which insights may the nurse gain as a result of this assessment? Select all that apply. A) Social habits B) Psychologic factors C) Presence of HIV D) Readiness for discharge E) Need for bed rest Explanation: A) The nurse may gain a view of both the woman's social habits and psychologic factors that may affect her birth experience. B) The nurse may gain a view of both the woman's social habits and psychologic factors that may affect her birth experience. 32) A newborn has the following applied to the umbilical cord. What should the nurse instruct the new parents about regarding this device? A) It has to stay intact for at least one week B) It is removed in 24 hours if the cord has dried C) It eliminates the need to wash the infant's abdomen D) It is removed by cutting the tissue beneath the clamp Explanation: B) The clamp is removed in the newborn nursery approximately 24 hours after birth if the cord has dried. The clamp does not stay intact for one week. The clamp does not eliminate the need to wash the infant's abdomen. A plastic device is used when removing the clamp. The tissue beneath the clamp is not cut. 33) The nurse determines that a newborn has the following findings: Heart rate: 88 beats per minute Respirations: 24 per minute and irregular Muscle tone: Minor movement of lower extremities Reflex response: Grimace Skin color: Pink body, blue extremities If using the following table, what action should the nurse take at this time? SCORE SIGN 0 1 2 Heart rate Absent Slow; less than 100 bests/min Greater than 100 beats/min Respiration Absent Slow; irregular Good breathing with crying Muscle tone Flaccid Slow flexion of extremities Active movement of extremities Reflex response Absent Grimace; noticeable facial movement Vigorous cry; coughs; sneezes, pulls away when touched Skin color Pale or blue Pink body, blue extremities Pink body and extremities A) Begin resuscitation B) Stimulate the infant C) Document the findings D) Nasopharyngeal suctioning Explanation: B) The infant's Apgar score is 5. An Apgar score between 4 and 7 indicates the need for stimulation. A score under 4 indicates the need for resuscitation. A score of 7 to 10 indicates a newborn in good condition who requires only nasopharyngeal suctioning. The nurse needs to do more than document the findings. 34) The nurse is observed performing the following with a patient: What information will this assessment technique provide to the nurse? A) Assesses for bladder distention B) Estimates the weight of the uterus C) Determines the height of the fundus D) Evaluates the remaining placenta contents Explanation: C) This is a technique used to palpate the fundus to determine if it needs to be massaged to reduce bleeding and enhance healing after delivery. This technique is not used to assess for bladder distention, estimate the weight of the uterus, or to evaluate for remaining placenta contents. Chapter 22: Pharmacologic Pain Management 1) The nurse is caring for a client in labor who has a history of physical dependence on narcotics. Which consideration should the nurse take with regard to the administration of naloxone (Narcan)? A) Inducing withdrawal symptoms B) Prolonging respiratory depression C) Exacerbating pruritis D) Increasing the risk for fetal depression Explanation: A) Administering naloxone (Narcan) to a client who is physically dependent on narcotics may induce withdrawal symptoms, which will adversely affect her and her baby. 2) An analgesic medication has been administered intramuscularly to a client in labor. How would the nurse evaluate if the medication was effective? A) The client dozes between contractions. B) The client is moaning during contractions. C) The contractions decrease in intensity. D) The contractions decrease in frequency. Explanation: A) If the client dozes between contractions, the analgesic is effective. Analgesics decrease discomfort and increase relaxation. 3) A client is having contractions that last 20-30 seconds and that are occurring every 8-20 minutes. The client is requesting something to help relieve the discomfort of contractions. What should the nurse suggest? A) That a mild analgesic be administered B) An epidural C) A local anesthetic block D) Nonpharmacologic methods of pain relief Explanation: D) For this pattern of labor, nonpharmacologic methods of pain relief should be suggested. These can include back rubs, providing encouragement, and clean linens. 4) Two hours after an epidural infusion has begun, a client complains of itching on her face and neck. What should the nurse do? A) Remove the epidural catheter and apply a Band-Aid to the injection site. B) Offer the client a cool cloth and let her know the itching is temporary C) Recognize that this is a common side effect, and follow protocol for administration of Benadryl. D) Call the anesthesia care provider to re-dose the epidural catheter. Explanation: C) Itching is a side effect of the medication used for an epidural infusion. Benadryl, an antihistamine, can be administered to manage pruritus. 5) A client has just been admitted for labor and delivery. She is having mild contractions lasting 30 seconds every 15 minutes. The client wants to have a medication-free birth. When discussing medication alternatives, the nurse should be sure the client understands which of the following? A) In order to respect her wishes, no medication will be given. B) Pain relief will allow a more enjoyable birth experience. C) The use of medications allows the client to rest and be less fatigued. D) Maternal pain and stress can have a more adverse effect on the fetus than would a small amount of analgesia. Explanation: D) The nurse can explain to the client that, although pharmacologic agents do affect the fetus, so does the pain and stress experienced by the laboring mother. If the woman's pain and anxiety are more than she can cope with, the adverse physiologic effects on the fetus may be as great as would occur with the administration of a small amount of an analgesic agent. Once the effects are explained, however, it is still the client's choice whether to receive medication. 6) A nurse is checking the postpartum orders. The doctor has prescribed bed rest for 6-12 hours. The nurse knows this is an appropriate order if the client had which type of anesthesia? A) Spinal B) Pudendal C) General D) Epidural Explanation: A) Following the birth, the woman may be kept flat. Although the effectiveness of the supine position to avoid headache following a spinal is controversial, the physician's orders may include lying flat for 6-12 hours. 7) Toward the end of the first stage of labor, a pudendal block is administered transvaginally. What will the nurse anticipate the client's care will include? A) Monitoring for hypotension every 15 minutes B) Monitoring FHR every 15 minutes C) Monitoring for bladder distention D) No additional assessments Explanation: D) Because a pudendal block is done using a local anesthetic, there is no need for additional monitoring of the mother or the fetus. 8) Narcotic analgesia is administered to a laboring client at 10:00 a.m. The infant is delivered at 12:30 p.m. What would the nurse anticipate that the narcotic analgesia could do? A) Be used in place of preoperative sedation B) Result in neonatal respiratory depression C) Prevent the need for anesthesia with an episiotomy D) Enhance uterine contractions Explanation: B) Analgesia given too late is of no value to the woman and may cause neonatal respiratory depression. 9) After nalbuphine hydrochloride (Nubain) is administered, labor progresses rapidly, and the baby is born less than 1 hour later. The baby shows signs of respiratory depression. Which medication should the nurse be prepared to administer to the newborn? A) Fentanyl (Sublimaze) B) Butorphanol tartrate (Stadol) C) Naloxone (Narcan) D) Pentobarbital (Nembutal) Explanation: C) Narcan is useful for respiratory depression caused by nalbuphine (Nubain). Respiratory depression in the mother or fetus/newborn can be improved by the administration of naloxone (Narcan), which is a specific antagonist for this agent. 10) The nurse has presented a session on pain relief options to a prenatal class. Which statement indicates that additional teaching is needed? A) "An epidural can be continuous or can be given in one dose." B) "A spinal is usually used for a cesarean birth." C) "Pudendal blocks are effective when a vacuum is needed." D) "Local anesthetics provide good labor pain relief." Explanation: D) Local anesthetics are not used for labor pain relief. They are used prior to episiotomy and for laceration repair. 11) What is the major adverse side effect of epidural anesthesia? A) Maternal hypotension B) Decrease in variability of the FHR C) Vertigo D) Decreased or absent respiratory movements Explanation: A) The major adverse effect of epidural anesthesia is maternal hypotension caused by a spinal blockade, which lowers peripheral resistance, decreases venous return to the heart, and subsequently lessens cardiac output and lowers blood pressure. 12) Prior to receiving lumbar epidural anesthesia, the nurse would anticipate placing the laboring client in which position? A) On her right side in the center of the bed with her back curved B) Lying prone with a pillow under her chest C) On her left side with the bottom leg straight and the top leg slightly flexed D) Sitting on the edge of the bed Explanation: D) The woman is positioned on her left or right side, at the edge of the bed with the assistance of the nurse, with her legs slightly flexed, or she is asked to sit on the edge of the bed. 13) The laboring client brought a written birth plan indicating that she wanted to avoid pain medications and an epidural. She is now at 6 cm and states, "I can't stand this anymore! I need something for pain! How will an epidural affect my baby?" What is the nurse's best response? A) "The narcotic in the epidural will make both you and the baby sleepy." B) "It is unlikely that an epidural will decrease your baby's heart rate." C) "Epidurals tend to cause low blood pressure in babies after birth." D) "I can't get you an epidural, because of your birth plan." Explanation: B) Maternal hypotension results in uteroplacental insufficiency in the fetus, which is manifested as late decelerations on the fetal monitoring strip. The risk of hypotension can be minimized by hydrating the vascular system with 500 to 1000 mL of IV solution before the procedure and changing the woman's position and/or increasing the IV rate afterward. 14) Upon the client's admission to the birthing unit, the nurse performs a careful assessment to determine whether the client has a history of physical dependence on narcotics. For which complication related to analgesic administration is the nurse preparing? A) Respiratory depression B) Urinary retention C) Fetal depression D) Pruritis Explanation: A) Respiratory depression may require the use of naloxone (Narcan) to reverse the effects of narcotic agents. If the client has a history of physical dependence on narcotics, naloxone (Narcan) may induce withdrawal symptoms, which will adversely affect the client and her baby. 15) During a labor and delivery class, a client asks the nurse, "Why would I be placed under general anesthesia during delivery?" What should the nurse include in the response? Select all that apply. A) Perceived lack of time for regional anesthesia B) Contraindications for regional anesthesia C) Failure of regional anesthesia D) Refusal of regional anesthesia E) Provider preference over regional anesthesia Explanation: A) Perceived lack of time is a common indication for general anesthesia. B) When regional anesthesia is contraindicated, general anesthesia is commonly used. C) Failure of regional anesthesia is a common indication for general anesthesia. D) Patient refusal of regional anesthesia is a common indication for general anesthesia. 16) The nurse knows that which of the following are advantages of spinal block? Select all that apply. A) Intense blockade of sympathetic fibers B) Relative ease of administration C) Maternal compartmentalization of the drug D) Immediate onset of anesthesia E) Larger drug volume Explanation: B) One of the advantages of spinal block is the relative ease of administration. C) One of the advantages of spinal block is the maternal compartmentalization of the drug. D) One of the advantages of spinal block is the immediate onset of anesthesia. 17) For what common side effects of epidural anesthesia should the nurse watch? Select all that apply. A) Elevated maternal temperature B) Urinary retention C) Nausea D) Long-term back pain E) Local itching Explanation: A) Elevated maternal temperature is a potential side effect of epidural anesthesia. B) Urinary retention is a potential side effect of epidural anesthesia. C) Nausea is a potential side effect of epidural anesthesia. E) Pruritus may occur at any time during the epidural infusion. It usually appears first on the face, neck, or torso and is generally the result of the agent used in the epidural infusion. Benadryl, an antihistamine, can be administered to manage pruritus. 18) A client dilated to 5 cm has just received an epidural for pain. She complains of feeling lightheaded and dizzy within 10 minutes after the procedure. Her blood pressure was 120/80 before the procedure and is now 80/52. In addition to the bolus of fluids she has been given, which medication is preferred to increase her BP? A) Epinephrine B) Terbutaline C) Ephedrine D) Epifoam Explanation: C) Ephedrine is the medication of choice to increase maternal blood pressure. 19) A client received epidural anesthesia during the first stage of labor. The epidural is discontinued immediately after delivery. This client is at increased risk for which problem during the fourth stage of labor? A) Nausea B) Bladder distention C) Uterine atony D) Hypertension Explanation: B) Nursing care following an epidural block includes frequent assessment of the bladder to avoid bladder distention. 20) When general anesthesia is necessary for a cesarean delivery, what should the nurse be prepared to do? Select all that apply. A) Administer an antacid to the client. B) Place a wedge under the client's thigh. C) Apply cricoid pressure to the client during anesthesia intubation. D) Preoxygenate the client for 3-5 minutes before anesthesia. E) Place a Foley catheter in the client's bladder. Explanation: A) Prophylactic antacid therapy is given to reduce the acidic content of the stomach before general anesthesia. C) During the process of rapid induction of anesthesia, the nurse applies cricoid pressure. D) The woman should be preoxygenated with 3 to 5 minutes of 100% oxygen. E) Urinary retention can be treated with the placement of an indwelling Foley catheter. 21) The client at 39 weeks' gestation is undergoing a cesarean birth due to breech presentation. General anesthesia is being used. Which situation requires immediate intervention? A) The baby's hands and feet are blue at 1 minute after birth. B) The fetal heart rate is 70 prior to making the skin incision. C) Clear fluid is obtained from the baby's oropharynx. D) The neonate cries prior to delivery of the body. Explanation: B) Fetal bradycardia occurs when the fetal heart rate falls below 110 beats/minute during a 10- minute period of continuous monitoring. When fetal bradycardia is accompanied by decreased variability, it is considered ominous and could be a sign of fetal compromise. 22) The nurse is providing preoperative teaching to a client for whom a cesarean birth under general anesthesia is scheduled for the next day. Which statement by the client indicates that she requires additional information? A) "General anesthesia can be accomplished with inhaled gases." B) "General anesthesia usually involves administering medication into my IV." C) "General anesthesia will provide good pain relief after the birth." D) "General anesthesia takes effect faster than an epidural." Explanation: C) General anesthesia provides no pain relief after birth, as regional anesthesia does. 23) A cesarean section is ordered for a pregnant client. Because the client is to receive general anesthesia, what is the primary danger with which the nurse is concerned? A) Fetal depression B) Vomiting C) Maternal depression D) Uterine relaxation Explanation: A) A primary danger of general anesthesia is fetal depression. The depression in the fetus is directly proportional to the depth and duration of the anesthesia. 24) A cesarean section is ordered for the laboring client with whom the nurse has worked all shift. The client will receive general anesthesia. The nurse knows that potential complications of general anesthesia include which of the following? Select all that apply. A) Fetal depression that is directly proportional to the depth and duration of the anesthesia B) Poor fetal metabolism of anesthesia, which inhibits use with preterm infants C) Uterine relaxation D) Increased gastric motility E) Itching of the face and neck Explanation: A) A primary danger of general anesthesia is fetal depression, because the medication reaches the fetus in about 2 minutes. The depression is directly proportional to the depth and duration of anesthesia. B) The poor fetal metabolism of general anesthetic agents is similar to that of analgesic agents administered during labor. General anesthesia is not advocated when the fetus is considered to be at high risk, particularly in preterm birth. C) Most general anesthetic agents cause some degree of uterine relaxation. 25) The client with a normal pregnancy had an emergency cesarean birth under general anesthesia 2 hours ago. The client now has a respiratory rate of 30, pale blue nail beds, a pulse rate of 110, and a temperature of 102.6°F, and is complaining of chest pain. The nurse understands that the client most likely is experiencing which of the following? A) Pulmonary embolus B) Pneumococcal pneumonia C) Pneumonitis D) Gastroesophageal reflux disease Explanation: C) Even when food and fluids have been withheld, the gastric juice produced during fasting is highly acidic and can produce chemical pneumonitis if aspirated. This pneumonitis is known as Mendelson syndrome. The signs and symptoms are chest pain, respiratory distress, cyanosis, fever, and tachycardia. Women undergoing emergency cesarean births appear to be at considerable risk for adverse events. 26) The nurse is inducing the labor of a client with severe preeclampsia. As labor progresses, fetal intolerance of labor develops. The induction medication is turned off, and the client is prepared for cesarean birth. Which statement should the nurse include in her preoperative teaching? A) "Because of your preeclampsia, you are at higher risk for hypotension after an epidural anesthesia." B) "Because of your preeclampsia, you might develop hypertension after a spinal anesthesia." C) "Because of your preeclampsia, your baby might have decreased blood pressure after birth." D) "Because of your preeclampsia, your husband will not be allowed into the operating room." Explanation: A) Pregnancies complicated by preeclampsia are high-risk situations. The woman with mild preeclampsia usually may have the analgesia or anesthesia of choice, although the incidence of hypotension with epidural anesthesia is increased. If hypotension occurs with the epidural block, it provides further stress on an already compromised cardiovascular system. 27) The nurse is caring for a laboring client with thrombocytopenia. During labor, it is determined that the client requires a cesarean delivery. The nurse is preparing the client for surgery, and should instruct the client that the recommended method of anesthesia is which of the following? A) General anesthesia B) Epidural anesthesia C) Spinal anesthesia D) Regional anesthesia Explanation: A) General anesthesia will be recommended. Women with thrombocytopenia should avoid regional blocks. 28) The nurse is performing an assessment on a client admitted to the birthing unit. Which assessment finding(s) contraindicate(s) an epidural block? Select all that apply. A) Maternal refusal B) Local infection of the skin on the lower back C) Coagulation disorder D) Long-term NSAID use E) Previous back surgery Explanation: A) Maternal refusal is an absolute contraindication to an epidural block. B) Local infection is an absolute contraindication to an epidural block. C) Coagulation disorders are an absolute contraindication to an epidural block. 29) A patient is labor is prescribed to receive nalbuphine 10 mg/70 kg intravenously now. The patient weighs 198 lbs. How many mg of medication should the nurse provide this patient? (Round to the nearest tenth decimal point.) Answer: 12.9 mg Explanation: First calculate the patient's weight in kg by dividing the weight in lb by 2.2 or 198/2.2 = 90 kg. Then set up the equation 10 mg/70 kg = x/90 kg. When cross-multiplying, the equation will be 10/70 = x/90; 70x = 900. Then solve for x by dividing 900/70 = 12.85 mg. When rounding to the nearing tenth decimal point the dose should be 12.9 mg. 30) The nurse is preparing to instruct a patient in the third trimester of pregnancy on various methods to control pain during labor, and selects the following diagram. For which type of pain control is the nurse planning to instruct the client? A) Lumbar spinal block B) Pudendal block C) Lumbar epidural block D) Local infiltration Explanation: C) A lumbar epidural block is placed within the epidural space and affects a larger area of nerves to include the uterus, cervix, vagina, and perineum. In this diagram the dark area demonstrates the peridural (epidural) space and nerves affected, and the gray tube represents a continuous plastic catheter. A lumbar sympathetic (spinal) block relieves uterine pain only. A pudendal block relieves perineal pain only. Local infiltration affects the perineum only. 31) A patient in labor is being prepared for an epidural. Where should the nurse indicate the location of the epidural space on the diagram below? 1. A 2. B 3. C 4. D Explanation: The epidural space lies between the dura mater and the ligamentum flavum, extending from the base of the skull to the end of the sacral canal. 32) The nurse is reviewing the procedure for a continuous lumbar epidural block with a patient in the 3rd trimester of pregnancy. When reviewing this information what does the following diagram demonstrate to the patient? A) Preparation of the skin prior to the insertion of the catheter B) Status of the vertebra when the patient is in the correct position C) The length of the needle to be inserted in the subarachnoid space D) Vertebrae rotated forward when the patient is side-lying without a pillow Explanation: B) This picture diagrams the position that the vertebrae need to be in for insertion of the epidural. Preparation of the skin prior to the insertion of the catheter would not be completed with a needle and syringe. The length of the needle to be inserted is not usually a part of patient teaching about the procedure. The vertebrae are not rotated forward in this picture. 33) A patient is having the following anesthesia provided. What is the purpose of this type of anesthesia? A) Repair of an episiotomy B) Delivery of the placenta C) Insertion of a urinary catheter D) Intrapartum vaginal examination Explanation: A) This is a picture of local infiltration anesthesia which is used to repair an episiotomy. This anesthesia is not used to deliver the placenta, insert a urinary catheter, or conduct an intrapartum vaginal examination. Chapter 23: Childbirth at Risk: Prelabor Onset Complications 1) A client is admitted to the labor and delivery unit with a history of ruptured membranes for 2 hours. This is her sixth delivery; she is 40 years old, and smells of alcohol and cigarettes. What is this client at risk for? A) Gestational diabetes B) Placenta previa C) Abruptio placentae D) Placenta accreta Explanation: C) Abruptio placentae is more frequent in pregnancies complicated by smoking, premature rupture of membranes, multiple gestation, advanced maternal age, cocaine use, chorioamnionitis, and hypertension. 2) The nurs