Maternity/OB HESI Practice Part #1 University of
Michigan-Ann Arbor NURS 245 QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+
1. The nurse has just received report on a labor client: a G3 T1 P0 Ab1 L1who is
80/3/0, (80% effaced, 3 cm dilated, 0 station). The nurse anticipates the plan of care for
the next shift will include which of the following? Select all that apply.
1. A birth before the change of shift in 12 hours.
2. Pushing the baby out should take 30 minutes or less.
3. Contractions will remain irregular until transition.
4. Transition will be shorter for this multiparous client.
5. This client will withdraw into herself during transition. - answer :41. 1,2,4,5. A multiparous client
usually gives birth within 12 hours of the time
labor began. The pushing phase statistically takes 30 minutes or less and many
multiparous clients go immediately from 10-cm dilation to birth. Contractions become
regular and increase in frequency, intensity, and duration as labor progresses for both
primiparous and multiparous clients. Transition will be shorter for a multiparous client
than it will for a primiparous client, as the entire labor process takes less time for
someone who has had a baby before. This client will withdraw into herself during
transition and this is a common characteristic for those in the transition phase.
2. A multigravida in active labor is 7 cm dilated. The fetal heart rate baseline is
130 bpm with moderate variability. The client begins to have variable decelerations to
,100 to 110 bpm. What should the nurse do next?
1. Perform a vaginal examination.
2. Notify the primary health care provider of the decelerations.
3. Reposition the client and continue to evaluate the tracing.
4. Administer oxygen via mask at 2 L/min. - answer :42. 3. The cause of variable decelerations is cord
compression, which may be
relieved by moving the client to one side or another. If the client is already on the left
side, changing the client to the right side is appropriate. Performing a vaginal
examination will let the nurse know how far dilated the client is but will not relieve the
cord compression. If the decelerations are not relieved by position changes, oxygen
should be initiated but the rate should be 8 to 10 L/min. Notifying the primary health
care provider should occur if turning the client and administering oxygen do not relieve
the decelerations.
3. A nurse is preparing a change-of-shift report and has been caring for a
multigravid client with a normally progressing labor. Which of the following
information should be part of this report? Select all that apply.
1. Interpretation of the fetal monitor strip.
2. Analgesia or anesthesia being used.
3. Anticipated method of birth control.
4. Amount of vaginal bleeding or discharge.
5. Support persons with the client.
6. Prior birth history. - answer :43. 1,2,4,5,6. Knowledge of how the fetus is tolerating contractions as
well as the
frequency, intensity, and duration of contractions, as indicated on the fetal monitor strip,
are extremely important. The type of analgesia or anesthesia being used, the client's
response, and her pain rating should be included as well. The amount of vaginal
bleeding indicates whether this labor is in the normal range. Vaginal discharge indicates
if membranes are ruptured and the color, odor, and amount of amniotic fluid. The
,support persons with the client are an integral part of the labor process and greatly
influence how she manages labor emotionally and, commonly, physically. A complete
change-of-shift report would include the client's name, age, gravida and parity, current
and prior illnesses that may influence this hospitalization, prior labor and birth history if
applicable, last vaginal examination time and findings, vaginal bleeding, support
persons with client, current IVs and other medications being used, and pertinent
laboratory test results. Future plan for birth control would be the least important
information to be given to the next shift because it will not impact the labor care plan.
4. A multigravid client is admitted at 4-cm dilation and requesting pain
medication. The nurse gives the client nalbuphine 15 mg. Within 5 minutes, the client
tells the nurse she feels like she needs to have a bowel movement. The nurse should
first:
1. Have naloxone hydrochloride (Narcan) available in the birthing room.
2. Complete a vaginal examination to determine dilation, effacement, and station.
3. Prepare for birth.
4. Document the client's relief due to pain medication. - answer :44. 2. The feeling of needing to have a
bowel movement is commonly caused by
pressure on the receptors low in the perineum when the fetal head is creating pressure
on them. This feeling usually indicates advances in fetal station and that the client may
be close to birth. The nurse should respond initially to the client's signs and symptoms
by checking to validate current effacement, dilation, and station. If the fetus is ready to
be born, having the room ready for the birth and having naloxone hydrochloride
(Narcan) available are important. Narcan completely or partially reverses the effects of
natural and synthetic opioids, including respiratory depression. Documenting pain relief
takes time away from the vaginal examination, preparing for birth, and obtaining
Narcan. The birth may be occurring rapidly. Being prepared for the birth is a higher
priority than documentation for this client.
, 5. A multigravid laboring client has an extensive documented history of drug
addiction. Her last reported usage was 5 hours ago. She is 2 cm dilated with
contractions every 3 minutes of moderate intensity. The primary health care provider
prescribes nalbuphine 15 mg slow IV push for pain relief followed by an epidural when
the client is 4 cm dilated. Within 10 minutes of receiving the nalbuphine, the client
states she thinks she is going to have her baby now. Of the following drugs available at
the time of the birth, which should the nurse avoid using with this client in this situation?
1. 1% lidocaine (Xylocaine).
2. Naloxone hydrochloride (Narcan).
3. Local anesthetic.
4. Pudendal block. - answer :45. 2. Naloxone hydrochloride (Narcan) would not be used in a client who
has a
history of drug addiction. Narcan would abruptly withdraw this woman from the drug
she is addicted to as well as the nalbuphine. The withdrawal would occur within a few
minutes of injection and, if severe enough, could jeopardize the mother and fetus.
Xylocaine is a local anesthetic and numbs rather than decreases the effects of Narcan.
The local anesthetic and the pudendal block are both appropriate for this birth but are
used to numb the maternal perineum for birth.
6. A 31-year-old multigravid client at 39 weeks' gestation admitted to the hospital
in active labor is receiving intravenous lactated Ringer's solution and a continuous
epidural anesthetic. During the first hour after administration of the anesthetic, the nurse
should monitor the client for:
1. Hypotension.
2. Diaphoresis.
3. Headache.
4. Tremors. - answer :46. 1. When a client receives an epidural anesthetic, sympathetic nerves are
blocked
along with the pain nerves, possibly resulting in vasodilation and hypotension. Other
Michigan-Ann Arbor NURS 245 QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+
1. The nurse has just received report on a labor client: a G3 T1 P0 Ab1 L1who is
80/3/0, (80% effaced, 3 cm dilated, 0 station). The nurse anticipates the plan of care for
the next shift will include which of the following? Select all that apply.
1. A birth before the change of shift in 12 hours.
2. Pushing the baby out should take 30 minutes or less.
3. Contractions will remain irregular until transition.
4. Transition will be shorter for this multiparous client.
5. This client will withdraw into herself during transition. - answer :41. 1,2,4,5. A multiparous client
usually gives birth within 12 hours of the time
labor began. The pushing phase statistically takes 30 minutes or less and many
multiparous clients go immediately from 10-cm dilation to birth. Contractions become
regular and increase in frequency, intensity, and duration as labor progresses for both
primiparous and multiparous clients. Transition will be shorter for a multiparous client
than it will for a primiparous client, as the entire labor process takes less time for
someone who has had a baby before. This client will withdraw into herself during
transition and this is a common characteristic for those in the transition phase.
2. A multigravida in active labor is 7 cm dilated. The fetal heart rate baseline is
130 bpm with moderate variability. The client begins to have variable decelerations to
,100 to 110 bpm. What should the nurse do next?
1. Perform a vaginal examination.
2. Notify the primary health care provider of the decelerations.
3. Reposition the client and continue to evaluate the tracing.
4. Administer oxygen via mask at 2 L/min. - answer :42. 3. The cause of variable decelerations is cord
compression, which may be
relieved by moving the client to one side or another. If the client is already on the left
side, changing the client to the right side is appropriate. Performing a vaginal
examination will let the nurse know how far dilated the client is but will not relieve the
cord compression. If the decelerations are not relieved by position changes, oxygen
should be initiated but the rate should be 8 to 10 L/min. Notifying the primary health
care provider should occur if turning the client and administering oxygen do not relieve
the decelerations.
3. A nurse is preparing a change-of-shift report and has been caring for a
multigravid client with a normally progressing labor. Which of the following
information should be part of this report? Select all that apply.
1. Interpretation of the fetal monitor strip.
2. Analgesia or anesthesia being used.
3. Anticipated method of birth control.
4. Amount of vaginal bleeding or discharge.
5. Support persons with the client.
6. Prior birth history. - answer :43. 1,2,4,5,6. Knowledge of how the fetus is tolerating contractions as
well as the
frequency, intensity, and duration of contractions, as indicated on the fetal monitor strip,
are extremely important. The type of analgesia or anesthesia being used, the client's
response, and her pain rating should be included as well. The amount of vaginal
bleeding indicates whether this labor is in the normal range. Vaginal discharge indicates
if membranes are ruptured and the color, odor, and amount of amniotic fluid. The
,support persons with the client are an integral part of the labor process and greatly
influence how she manages labor emotionally and, commonly, physically. A complete
change-of-shift report would include the client's name, age, gravida and parity, current
and prior illnesses that may influence this hospitalization, prior labor and birth history if
applicable, last vaginal examination time and findings, vaginal bleeding, support
persons with client, current IVs and other medications being used, and pertinent
laboratory test results. Future plan for birth control would be the least important
information to be given to the next shift because it will not impact the labor care plan.
4. A multigravid client is admitted at 4-cm dilation and requesting pain
medication. The nurse gives the client nalbuphine 15 mg. Within 5 minutes, the client
tells the nurse she feels like she needs to have a bowel movement. The nurse should
first:
1. Have naloxone hydrochloride (Narcan) available in the birthing room.
2. Complete a vaginal examination to determine dilation, effacement, and station.
3. Prepare for birth.
4. Document the client's relief due to pain medication. - answer :44. 2. The feeling of needing to have a
bowel movement is commonly caused by
pressure on the receptors low in the perineum when the fetal head is creating pressure
on them. This feeling usually indicates advances in fetal station and that the client may
be close to birth. The nurse should respond initially to the client's signs and symptoms
by checking to validate current effacement, dilation, and station. If the fetus is ready to
be born, having the room ready for the birth and having naloxone hydrochloride
(Narcan) available are important. Narcan completely or partially reverses the effects of
natural and synthetic opioids, including respiratory depression. Documenting pain relief
takes time away from the vaginal examination, preparing for birth, and obtaining
Narcan. The birth may be occurring rapidly. Being prepared for the birth is a higher
priority than documentation for this client.
, 5. A multigravid laboring client has an extensive documented history of drug
addiction. Her last reported usage was 5 hours ago. She is 2 cm dilated with
contractions every 3 minutes of moderate intensity. The primary health care provider
prescribes nalbuphine 15 mg slow IV push for pain relief followed by an epidural when
the client is 4 cm dilated. Within 10 minutes of receiving the nalbuphine, the client
states she thinks she is going to have her baby now. Of the following drugs available at
the time of the birth, which should the nurse avoid using with this client in this situation?
1. 1% lidocaine (Xylocaine).
2. Naloxone hydrochloride (Narcan).
3. Local anesthetic.
4. Pudendal block. - answer :45. 2. Naloxone hydrochloride (Narcan) would not be used in a client who
has a
history of drug addiction. Narcan would abruptly withdraw this woman from the drug
she is addicted to as well as the nalbuphine. The withdrawal would occur within a few
minutes of injection and, if severe enough, could jeopardize the mother and fetus.
Xylocaine is a local anesthetic and numbs rather than decreases the effects of Narcan.
The local anesthetic and the pudendal block are both appropriate for this birth but are
used to numb the maternal perineum for birth.
6. A 31-year-old multigravid client at 39 weeks' gestation admitted to the hospital
in active labor is receiving intravenous lactated Ringer's solution and a continuous
epidural anesthetic. During the first hour after administration of the anesthetic, the nurse
should monitor the client for:
1. Hypotension.
2. Diaphoresis.
3. Headache.
4. Tremors. - answer :46. 1. When a client receives an epidural anesthetic, sympathetic nerves are
blocked
along with the pain nerves, possibly resulting in vasodilation and hypotension. Other
