N144 Week 3 Elsevier Skills Modules Exam
Questions With Complete Solutions
A primipara at 39 weeks' gestation presents to the labor and delivery
| | | | | | | | | | | |
unit for cervical ripening to be followed by labor induction. The
| | | | | | | | | | |
practitioner orders misoprostol to be administered vaginally every 6
| | | | | | | | |
hours as needed to achieve a Bishop score of 8 or greater or until labor
| | | | | | | | | | | | | | |
begins. A nursing student on the unit asks the nurse why misoprostol is
| | | | | | | | | | | | |
being given first instead of oxytocin. What is the nurse's most accurate
| | | | | | | | | | | |
response?
A. "Misoprostol is used first to soften and thin the cervix, which may
| | | | | | | | | | | | |
reduce the amount of oxytocin needed to induce labor."
| | | | | | | |
B. "Misoprostol is more effective at labor induction; without it, higher
| | | | | | | | | | |
levels of oxytocin may be required."
| | | | |
C. "If misoprostol is used first, oxytocin most likely won't be necessary."
| | | | | | | | | | |
D. "Misoprostol works better than oxytocin for labor induction in term
| | | | | | | | | | |
gestations."
A. “Misoprostol is used first to soften and thin the cervix, which may
| | | | | | | | | | | | |
reduce the amount of oxytocin needed to induce labor.”
| | | | | | | |
Rationale: The goal of administering misoprostol first is to ripen the
| | | | | | | | | | |
cervix (soften and thin the cervix), so IV oxytocin will be more effective
| | | | | | | | | | | | |
,and less IV oxytocin will be required. Misoprostol and oxytocin work
| | | | | | | | | | |
differently, but not more or less effectively. In some cases, misoprostol
| | | | | | | | | | |
may induce labor and eliminate the need for oxytocin; however, in most
| | | | | | | | | | | |
cases in which cervical ripening is necessary, both medications are
| | | | | | | | | |
required. Misoprostol is generally used for cervical ripening at term, not
| | | | | | | | | | |
for labor induction.
| |
A patient admitted for labor induction at 40 weeks' gestation received a
| | | | | | | | | | | |
second vaginal dose of misoprostol 30 minutes ago. The nurse
| | | | | | | | | |
completes an assessment and observes that for the past 30 minutes,
| | | | | | | | | | |
each of the patient's contractions has lasted 90 seconds and there are
| | | | | | | | | | | |
six contractions in every 10-minute period. The FHR baseline is 170
| | | | | | | | | | |
beats per minute with minimal variability, no accelerations, and no
| | | | | | | | | |
decelerations; this is a change from the patient's admission tracing, | | | | | | | | | |
which showed an FHR of 145 beats per minute and moderate variability.
| | | | | | | | | | |
Based on the assessment, how should the nurse proceed?
| | | | | | | | |
A. Do nothing because this is an expected effect of misoprostol.
| | | | | | | | | |
B. Administer terbutaline as ordered, notify the practitioner, and
| | | | | | | | |
continue to monitor the situation. | | | |
C. Continue to monitor the patient closely because labor induction has
| | | | | | | | | | |
probably occurred. |
,D. Remove the misoprostol tablet (if possible), notify the practitioner,
| | | | | | | | | |
and administer terbutaline as ordered.
| | | |
D. Remove the misoprostol tablet (if possible), notify the practitioner,
| | | | | | | | | |
and administer terbutaline as ordered.
| | | |
Rationale: To prevent an interruption of fetal oxygenation, a uterine
| | | | | | | | | |
rupture, or other complications, the nurse should remove the tablet (if
| | | | | | | | | | |
possible), notify the practitioner in case emergency delivery is required,
| | | | | | | | | |
and obtain an order for a tocolytic to suppress contractions. The patient
| | | | | | | | | | | |
has developed tachysystole as a result of misoprostol administration.
| | | | | | | | |
Interruption of fetal oxygenation and uterine rupture are possible
| | | | | | | | |
severe adverse effects of misoprostol, and the tachysystole must be
| | | | | | | | | |
addressed. Close monitoring is necessary, and labor may have started;
| | | | | | | | | |
however, tachysystole may result in an interruption of fetal oxygenation
| | | | | | | | | |
that may require immediate delivery. The practitioner should be
| | | | | | | | |
notified; however, the misoprostol must be removed (if possible), and a
| | | | | | | | | | |
tocolytic agent must be administered to suppress contractions as soon
| | | | | | | | | |
as possible to prevent further fetal stress.
| | | | | |
A primipara at 42 weeks' gestation has received two doses of
| | | | | | | | | | |
misoprostol vaginally; the last dose was 6 hours ago. The nurse
| | | | | | | | | | |
completes an assessment to determine the need for additional doses of
| | | | | | | | | | |
misoprostol. Performing a sterile vaginal examination, the nurse
| | | | | | | |
determines that the patient's cervix is 6 cm dilated, 100% effaced, soft,
| | | | | | | | | | | |
, and at midposition and that the fetus is at -2 station. The patient's
| | | | | | | | | | | | |
membranes are intact, and contractions are occurring every 2 to 3
| | | | | | | | | | |
minutes. Based on these findings, what is the nurse's next appropriate
| | | | | | | | | | |
action?
A. Start oxytocin administration as ordered.
| | | | |
B. Notify the pharmacist to prepare another dose of misoprostol.
| | | | | | | | |
C. Notify the practitioner that labor has begun.
| | | | | | |
D. Determine whether the patient wants visitors at the bedside.
| | | | | | | | |
C. Notify the practitioner that labor has begun.
| | | | | | |
Rationale: The patient is in active labor, and the practitioner should be
| | | | | | | | | | | |
notified. Neither oxytocin nor another dose of misoprostol is needed.
| | | | | | | | | |
Although having visitors at the bedside may support the patient, their
| | | | | | | | | | |
presence would not physiologically impact labor.
| | | | |
A patient received a combination of mifepristone and oral misoprostol
| | | | | | | | | |
for medically induced abortion. On discharge, the nurse is explaining
| | | | | | | | | |
which symptoms to report to the practitioner immediately. What should
| | | | | | | | |
|the list include?
| |
A. No menstrual period after 3 weeks
| | | | | |
Questions With Complete Solutions
A primipara at 39 weeks' gestation presents to the labor and delivery
| | | | | | | | | | | |
unit for cervical ripening to be followed by labor induction. The
| | | | | | | | | | |
practitioner orders misoprostol to be administered vaginally every 6
| | | | | | | | |
hours as needed to achieve a Bishop score of 8 or greater or until labor
| | | | | | | | | | | | | | |
begins. A nursing student on the unit asks the nurse why misoprostol is
| | | | | | | | | | | | |
being given first instead of oxytocin. What is the nurse's most accurate
| | | | | | | | | | | |
response?
A. "Misoprostol is used first to soften and thin the cervix, which may
| | | | | | | | | | | | |
reduce the amount of oxytocin needed to induce labor."
| | | | | | | |
B. "Misoprostol is more effective at labor induction; without it, higher
| | | | | | | | | | |
levels of oxytocin may be required."
| | | | |
C. "If misoprostol is used first, oxytocin most likely won't be necessary."
| | | | | | | | | | |
D. "Misoprostol works better than oxytocin for labor induction in term
| | | | | | | | | | |
gestations."
A. “Misoprostol is used first to soften and thin the cervix, which may
| | | | | | | | | | | | |
reduce the amount of oxytocin needed to induce labor.”
| | | | | | | |
Rationale: The goal of administering misoprostol first is to ripen the
| | | | | | | | | | |
cervix (soften and thin the cervix), so IV oxytocin will be more effective
| | | | | | | | | | | | |
,and less IV oxytocin will be required. Misoprostol and oxytocin work
| | | | | | | | | | |
differently, but not more or less effectively. In some cases, misoprostol
| | | | | | | | | | |
may induce labor and eliminate the need for oxytocin; however, in most
| | | | | | | | | | | |
cases in which cervical ripening is necessary, both medications are
| | | | | | | | | |
required. Misoprostol is generally used for cervical ripening at term, not
| | | | | | | | | | |
for labor induction.
| |
A patient admitted for labor induction at 40 weeks' gestation received a
| | | | | | | | | | | |
second vaginal dose of misoprostol 30 minutes ago. The nurse
| | | | | | | | | |
completes an assessment and observes that for the past 30 minutes,
| | | | | | | | | | |
each of the patient's contractions has lasted 90 seconds and there are
| | | | | | | | | | | |
six contractions in every 10-minute period. The FHR baseline is 170
| | | | | | | | | | |
beats per minute with minimal variability, no accelerations, and no
| | | | | | | | | |
decelerations; this is a change from the patient's admission tracing, | | | | | | | | | |
which showed an FHR of 145 beats per minute and moderate variability.
| | | | | | | | | | |
Based on the assessment, how should the nurse proceed?
| | | | | | | | |
A. Do nothing because this is an expected effect of misoprostol.
| | | | | | | | | |
B. Administer terbutaline as ordered, notify the practitioner, and
| | | | | | | | |
continue to monitor the situation. | | | |
C. Continue to monitor the patient closely because labor induction has
| | | | | | | | | | |
probably occurred. |
,D. Remove the misoprostol tablet (if possible), notify the practitioner,
| | | | | | | | | |
and administer terbutaline as ordered.
| | | |
D. Remove the misoprostol tablet (if possible), notify the practitioner,
| | | | | | | | | |
and administer terbutaline as ordered.
| | | |
Rationale: To prevent an interruption of fetal oxygenation, a uterine
| | | | | | | | | |
rupture, or other complications, the nurse should remove the tablet (if
| | | | | | | | | | |
possible), notify the practitioner in case emergency delivery is required,
| | | | | | | | | |
and obtain an order for a tocolytic to suppress contractions. The patient
| | | | | | | | | | | |
has developed tachysystole as a result of misoprostol administration.
| | | | | | | | |
Interruption of fetal oxygenation and uterine rupture are possible
| | | | | | | | |
severe adverse effects of misoprostol, and the tachysystole must be
| | | | | | | | | |
addressed. Close monitoring is necessary, and labor may have started;
| | | | | | | | | |
however, tachysystole may result in an interruption of fetal oxygenation
| | | | | | | | | |
that may require immediate delivery. The practitioner should be
| | | | | | | | |
notified; however, the misoprostol must be removed (if possible), and a
| | | | | | | | | | |
tocolytic agent must be administered to suppress contractions as soon
| | | | | | | | | |
as possible to prevent further fetal stress.
| | | | | |
A primipara at 42 weeks' gestation has received two doses of
| | | | | | | | | | |
misoprostol vaginally; the last dose was 6 hours ago. The nurse
| | | | | | | | | | |
completes an assessment to determine the need for additional doses of
| | | | | | | | | | |
misoprostol. Performing a sterile vaginal examination, the nurse
| | | | | | | |
determines that the patient's cervix is 6 cm dilated, 100% effaced, soft,
| | | | | | | | | | | |
, and at midposition and that the fetus is at -2 station. The patient's
| | | | | | | | | | | | |
membranes are intact, and contractions are occurring every 2 to 3
| | | | | | | | | | |
minutes. Based on these findings, what is the nurse's next appropriate
| | | | | | | | | | |
action?
A. Start oxytocin administration as ordered.
| | | | |
B. Notify the pharmacist to prepare another dose of misoprostol.
| | | | | | | | |
C. Notify the practitioner that labor has begun.
| | | | | | |
D. Determine whether the patient wants visitors at the bedside.
| | | | | | | | |
C. Notify the practitioner that labor has begun.
| | | | | | |
Rationale: The patient is in active labor, and the practitioner should be
| | | | | | | | | | | |
notified. Neither oxytocin nor another dose of misoprostol is needed.
| | | | | | | | | |
Although having visitors at the bedside may support the patient, their
| | | | | | | | | | |
presence would not physiologically impact labor.
| | | | |
A patient received a combination of mifepristone and oral misoprostol
| | | | | | | | | |
for medically induced abortion. On discharge, the nurse is explaining
| | | | | | | | | |
which symptoms to report to the practitioner immediately. What should
| | | | | | | | |
|the list include?
| |
A. No menstrual period after 3 weeks
| | | | | |
