Labor & Delivery Exam (Latest 2023/2024 Update) Questions and Verified Answers| 100% Correct | Grade A

Labor & Delivery Exam (Latest 2023/2024 Update) Questions and Verified Answers| 100% Correct | Grade A Q: The nurse receives report for a client at 36 weeks gestation who is being transferred to the unit for labor induction from a rural health care facility with an intrauterine fetal demise of unknown duration. Which intervention is most important when receiving care of the client? 1. Apply tocodynamometer and evaluate current contraction pattern 2. Ask the client about the family's desire for speaking with a chaplain 3. Draw coagulation tests, fibrinogen, and complete blood count with platelets 4. Initiate oxytocin prescription to begin induction of labor Answer: 3. Draw coagulation tests, fibrinogen, and complete blood count with platelets Pregnant clients, especially those with placental abruption and intrauterine fetal demise, are at risk for disseminated intravascular coagulation (DIC). Thromboplastin from the retained dead fetus activates the clotting cascade, followed by consumption of clotting factors and platelets that leads quickly to life-threatening external and internal bleeding. Signs of DIC include frank external bleeding (eg, venipuncture site bleeding), signs of internal bleeding (eg, petechiae, ecchymosis), and organ damage from blood clotting (eg, respiratory distress, renal failure). Baseline laboratory tests (eg, coagulation studies, platelets, fibrinogen) and physical assessment for signs of DIC are a priority for at-risk clients because clotting and bleeding are often sudden and life-threatening (Option 3). Educational objective: Pregnant clients, especially those with placental abruption and intrauterine fetal demise, are at risk for developing disseminated intravascular coagulation (DIC). DIC can progress quickly; therefore, the nurse should prioritize assessment for any signs of DIC (eg, abnormal laboratory tests [coagulation studies, fibrinogen, platelets], signs of bleeding) before performing other interventions. Q: The labor and delivery nurse is receiving report for a pregnant client who is having a scheduled cesarean birth for placenta accreta. Which information is priority for the nurse to ascertain? 1. The client has a history of three previous cesarean births 2. The client has a signed consent form for a cesarean hysterectomy 3. The client has removed all metal jewelry and contact lenses 4. The client has two 18-gauge IVs and a blood type and crossmatch Answer: 4. The client has two 18-gauge IVs and a blood type and crossmatch Placenta accreta is a condition of abnormal placental adherence in which the placenta implants directly in the myometrium rather than the endometrium. Prenatal ultrasound usually detects placenta accreta, although detection can rarely occur after birth when the placenta is adherent (ie, retained placenta). A cesarean birth before term gestation at a facility with adequate resources (eg, blood products, intensive care unit) is recommended for clients with placenta accreta. The major complication of placenta accreta is life-threatening hemorrhage, which occurs during attempted placental separation. At least two large-bore IVs (eg, 18-gauge) and a blood type and crossmatch are priority concerns in case blood transfusions are necessary (Option 4). Educational objective: Placenta accreta occurs when the placenta adheres abnormally to the myometrium; attempted separation can result in life-threatening hemorrhage. Priority concerns include presence of at least two large-bore IVs and available blood products should hemorrhage occur. Q: A nulliparous client asks about being in "real" labor. The nurse should teach that which signs are most indicative of true labor? Select all that apply. 1. Contractions that increase in frequency 2. Contractions that lessen after resting 3. Increased blood-tinged, mucoid vaginal discharge 4. Pain in lower back that moves to lower abdomen 5. Progressive cervical effacement and dilation Answer: 1. Contractions that increase in frequency 4. Pain in lower back that moves to lower abdomen 5. Progressive cervical effacement and dilation A key indicator of true labor is the progressive effacement and dilation of the cervix (Option 5). Contractions in true labor are regular, and increase in frequency, duration, and intensity (Option 1). The pain may initially start in the lower back and radiate to the abdomen (Option 4). Educational objective:During true labor, contractions increase in frequency, duration, and intensity over time, resulting in progressive dilation and effacement of the cervix. Clients in true labor often experience discomfort in the lower back that radiates to the abdomen with contractions. Contractions associated with true labor do not lessen or dissipate with comfort measures. Q: The nurse is caring for a client at 39 weeks gestation in active labor who is receiving an oxytocin infusion. The nurse notes persistent late decelerations on the fetal monitor. Which of the following actions should the nurse take? Select all that apply. 1. Administer oxygen via a nonrebreather face mask 2. Change maternal position to the left side 3. Discontinue the oxytocin infusion 4. Notify the health care provider 5. Perform a nitrazine test Answer: 1. Administer oxygen via a nonrebreather face mask 2. Change maternal position to the left side 3. Discontinue the oxytocin infusion 4. Notify the health care provider The mnemonic VEAL CHOP may help nurses recall causes of fetal heart rate (FHR) changes noted on monitor tracings. A late deceleration is a decrease in FHR that begins after a contraction, reaches its lowest point (nadir) after the contraction peak, and then gradually returns to baseline. Late decelerations indicate impaired fetal oxygenation associated with decreased uteroplacental perfusion (eg, due to maternal hypotension after epidural placement or uterine tachysystole). Chronic uteroplacental insufficiency (eg, intrauterine growth restriction, preeclampsia, diabetes) may also cause late decelerations. Nursing actions to improve fetal perfusion and oxygenation include: Discontinuing uterotonics (eg, oxytocin [Pitocin]) to reduce uterine activity (Option 3) Changing maternal position to the left side to relieve compression of the inferior vena cava. If the FHR tracing does not improve, a right-side position may be attempted (Option 2) Administering oxygen at 8-10 L/min via nonrebreather face mask to promote fetal oxygenation (Option 1) Giving prescribed IV bolus of lactated Ringer solution or normal saline to improve placental perfusion, especially during maternal hypotension Notifying the health care provider (Option 4) Educational objective:Late decelerations are evidence of impaired fetal oxygenation. Discontinuing the oxytocin infusion, changing maternal position, administering oxygen, and giving an IV fluid bolus are essential interventions. Q: A client gives birth within an hour of arriving at the labor and delivery unit and delivers the placenta 5 minutes later. During assessment, the nurse notes that the uterus is midline and boggy. Which action should the nurse take first? 1. Check for pooled blood under buttocks 2. Increase IV oxytocin infusion rate 3. Monitor blood pressure and pulse 4. Perform firm fundal massage Answer: 4. Perform firm fundal massage After delivery of the placenta, the uterus begins the process of involution. The uterus should be firmly contracted, midline, and at or slightly below the umbilicus. A boggy uterus indicates uterine atony, a state in which the uterus fails to contract adequately and compress vessels at the placental detachment site. This may lead to excessive blood loss and clots. The initial nursing action for uterine atony with a midline fundus is fundal massage, which stimulates contraction of the uterine smooth muscle (Option 4). If the uterus becomes firm with massage, the nurse should continue to monitor uterine tone, position, and lochia at least every 15 minutes in the initial hour after birth. Educational objective:After placenta delivery, the fundus should be firm, midline, and at or slightly below the umbilicus. The initial nursing action to correct uterine atony with a midline, boggy uterus is fundal massage. Q: Following the precipitous birth of a term newborn, what is the best action by the nurse while awaiting expulsion of the placenta and arrival of the health care provider? 1. Clean the perineal area 2. Gently pull on the cord 3. Keep the infant warm 4. Massage the fundus Answer: 3. Keep the infant warm Precipitous birth occurs when the newborn is delivered ≤3 hours after the onset of contractions. In the event of precipitous labor, the nurse should be prepared to assist with the birth if the health care provider is unable to arrive in time. Immediately after the birth, the newborn should be dried and placed skin-to-skin on the mother's abdomen at uterine level to promote warmth; this prevents cold stress that can lead to newborn hypoglycemia or respiratory distress (Option 3). If the newborn is stable, the cord can be clamped and cut with sterile scissors after it has stopped pulsating or after the placenta has been expelled. Educational objective: Precipitous birth occurs when delivery takes place ≤3 hours after the onset of contractions. The nurse should prevent newborn cold stress by promptly drying and placing the newborn on the mother's abdomen for skin-to-skin contact. Q: A laboring client at 35 weeks gestation comes to the labor and delivery unit with preterm rupture of membranes "about 18 hours ago." The client's group B Streptococcus status is unknown. What intervention is a priority for this client? 1. Administration of prophylactic antibiotics