INTRAPARTUM QUIZ (MCN2) COMPLETE ANSWERED TEST FALL 2024

DIESTRO, SAM LOIS D. INTRAPARTUM QUIZ (MCN2) 1. A primigravid client at 39 weeks' gestation is admitted to the hospital for induction of labor. The primary health care provider has prescribed prostaglandin E2 gel (Dinoprostone) for the client. Before administering prostaglandin E2 gel to the client, which of the following should the nurse do first? a. Assess the frequency of uterine contractions. b. Place the client in a side-lying position c. Prepare the client for an amniotomy. d. Determine whether the membranes have ruptured 2. The nurse is reviewing the health care provider’s (HCP’s) prescriptions for a client admitted for premature rupture of the membranes. Gestational age of the fetus is determined to be 37 weeks. Which prescription should the nurse question? a. Administer ampicillin 1 g as an intravenous piggyback every 6 hours. b. Monitor maternal vital signs frequently. c. Monitor fetal heart rate continuously d. Perform a vaginal examination every shif 3. The nurse has developed a plan of care for a client experiencing dystocia and includes several nursing actions in the plan of care. What is the priority nursing action? a. Changing the client’s position frequently b. Keeping the significant other informed of the progress of the labor c. Monitoring the fetal heart rate d. Providing comfort measures 4. The primary health care provider determines that outlet forceps are needed to assist in the birth of a primigravid client in active labor with a large-for-gestational-size fetus. The nurse reinforces the primary health care provider's explanation for using forceps based on the understanding about which of the following concerning the location of the fetal skull? a. It has reached the level of the ischial spines b. It is engaged past the inlet. c. It is at +1 station. d. It is visible at the perineal floor 5. Fetal distress is occurring with a laboring client. As the nurse prepares the client for a cesarean birth, what is the most important nursing action? a. Administer oxygen, 8 to 10 L/minute, via face mask b. Slow the intravenous flow rate c. Continue the oxytocin (Pitocin) drip if infusing d. Place the client in a high Fowler’s position6. The nurse in a labor room is performing a vaginal assessment on a pregnant client in labor. The nurse notes the presence of the umbilical cord protruding from the vagina. What is the first nursing action with this finding? a. Gently push the cord into the vagina b. Call the delivery room to notify the staff that the client will be transported immediately. c. Place the client in Trendelenburg’s position. d. Find the closest telephone and page the health care provider stat. 7. The nurse is planning care for a postpartum client who had a vaginal delivery 2 hours ago. The client had a midline episiotomy and has several hemorrhoids. What is the priority nursing consideration for this client? a. Inadequate urinary output b. Client pain level c. Client perception of body changes d. Potential for imbalanced body fluid volume 8. A nurse is preparing to assess the uterine fundus of a client in the immediate postpartum period. After locating the fundus, the nurse notes that the uterus feels soft and boggy. Which nursing intervention would be most appropriate? a. Ask the client to turn on her left side b. Push on the uterus to assist in expressing clots c. Elevate the client’s legs d. Massage the fundus until it is firm 9. The nurse is caring for four 1-day postpartum clients. Which client would require further nursing action? a. The client with lochia that is red and has a foul-smelling odor b. The client with a pulse rate of 60 beats/minute c. The client with mild after pains d. The client with colostrum discharge from both breasts 10. A pregnant woman at 39 weeks’ gestation arrives in the triage area of the birthing unit, stating she thinks her “water broke.” What should the nurse do first a. Perform Leopold’s maneuvers to rule out a breech presentation b. Auscultate the fetal heart to determine fetal well-being. c. Check the vaginal introitus for the presence of the umbilical cord d. Do a nitrazine test on the vaginal fluid for verification of ruptured membranes11. A client is admitted to the birthing unit in active labor. What should the nurse expect after an amniotomy is performed? a. Progressive dilation and effacement b. Less discomfort with contractions c. Increased and more variable FHR d. Diminished bloody show 12. A primigravida who is at 40 weeks’ gestation arrives at the birthing center with abdominal cramping and a bloody show. Her membranes ruptured 30 minutes before arrival. A vaginal examination reveals 1 cm dilation and the presenting part at −1 station. After obtaining the fetal heart rate and maternal vital signs, what should the nurse do next? a. Provide the client with comfort measures used for women in labor b. Teach the client how to push with each contraction c. Prepare to have the client’s blood typed and crossmatched for a possible transfusion. d. Encourage the client to perform pattern-paced breathing 13. A primiparous client who was diagnosed with hydramnios and breech presentation while in early labor is diagnosed with early postpartum hemorrhage at 1 hour after a cesarean birth. The client asks, “Why am I bleeding so much?” The nurse responds based on the understanding that the most likely cause of uterine atony in this client is which of the following? a. Trauma during labor and birth b. Overdistention of the uterus from hydramnios c. Moderate fundal massage after birth. d. Lengthy and prolonged second stage of labor. 14. A 30-year-old G 3, P 2 is being monitored internally. She is being induced with IV oxytocin because she is postterm. The nurse notes late decelerations. The client is wedged to her side while lying in bed and is approximately 6 cm dilated and 100% effaced. The nurse should first: a. . Continue to observe the fetal monitor b. Discontinue the oxytocin infusion c. Anticipate rupture of the membranes d. Prepare for fetal oximetry.15. A multigravid client is admitted to the labor area from the emergency room. At the time of admission, the fetal head is crowning, and the client yells, “The baby's coming!” To help the client remain calm and cooperative during the imminent birth, which of the following responses by the nurse is most appropriate? a. “Please don't push because you'll tear your cervix.” b. “I'll explain what's happening to guide you as we go along.” c. “Your doctor will be here as soon as possible.” d. “You're right; the baby is coming, so just relax.” 16. The nurse is caring for a primiparous client and her neonate immediately after birth. The neonate was born at 41 weeks' gestation and weighs 4,082 g (9 lb). Assessing for signs and symptoms of which of the following conditions should be a priority in this neonate? a. Hypoglycemia. b. Delayed meconium c. Anemia d. Elevated bilirubin 17. The nurse is performing an initial assessment on a client who has just been told that a pregnancy test is positive. Which assessment finding indicates that the client is at risk for preterm labor? a. The client has a history of cardiac disease b. The client’s hemoglobin level is 13.5 g/dL c. The client is a 20-year-old primigravida of average weight and height d. The client is a 35-year-old primigravida 18. A 28-year-old multigravid client at 28 weeks' gestation diagnosed with acute pyelonephritis is receiving intravenous fluids and antibiotics. After teaching the client about the rationale for the aggressive therapy, the nurse determines that the client needs further instruction when she says that acute pyelonephritis can lead to which of the following? a. Congenital fetal anomalies b. Intrauterine growth retardation c. Preterm labor d. Maternal sepsis19. A multigravid client at 34 weeks' gestation who is leaking amniotic fluid has just been hospitalized with a diagnosis of preterm premature rupture of membranes and preterm labor. The client's contractions are 20 minutes apart, lasting 20 to 30 seconds. Her cervix is dilated to 2 cm. The nurse reviews the physician prescriptions. Which of the following prescriptions should the nurse initiate first? a. Administer betamethasone. b. Start the intravenous infusion. c. Initiate fetal and contraction monitoring. d. Obtain the urine specimen 20. A client asks the nurse at the prenatal clinic whether she can continue to have sexual relations while pregnant. What is an indication that the client should refrain from intercourse during pregnancy? a. Fetal tachycardia b. Premature rupture of membranes c. Presence of leukorrhea d. Being close to expected date of birth 21. A client in preterm labor (31 weeks) who is dilated to 4 cm has been started on magnesium sulfate and contractions have stopped. If the client’s labor can be inhibited for the next 48 hours, the nurse anticipates a prescription for which medication? a. Nalbuphine (Nubain) b. Rho(D) immune globulin (RhoGAM) c. Betamethasone (Celestone) d. Dinoprostone (Cervidil vaginal insert) 22. During the first hour after a precipitous birth, the nurse should monitor a multiparous client for signs and symptoms of which of the following? a. Uterine atony. b. Postpartum “blues.” c. Intrauterine infection d. Urinary tract infection 23. The nurse in the labor and birth area receives a telephone call from the emergency room announcing that a multigravid client in active labor is being transferred to the labor area. The client has had no prenatal care. When the client arrives by stretcher, she says, “I think the baby's coming … Help!” The fetal skull is crowning. The nurse should obtain which of the following information first? a. Estimated date of birth b. Gravida and parity. c. Amniotic fluid statusd. Prenatal history 24. A 30-year-old woman, G 4, P 4, has given cesarean birth to a healthy term female neonate due to an abnormal fetal heart rate tracing. At 2 hours postpartum, the nurse assesses the client's Foley catheter and observes that the client's urine is slightly red tinged. Which of the following should the nurse do next? a. Assess the placement of the Foley catheter b. Continue to monitor the client's input and output c. Contact the client's physician for further prescriptions d. Palpate the client's fundus gently every 15 minutes 25. During the first hour postpartum, assessment of a multiparous client who gave cesarean birth to a neonate weighing 4,593 g (10 lb, 2 oz) reveals a soft fundus with excessive lochia rubra. The nurse should include which of the following in the client's plan of care? a. Rigorous fundal massage every 5 minutes b. Preparation for an emergency hysteromyomectomy c. Placement of the client in a side-lying position d. Administration of intravenous oxytocin 26. A primiparous client who was diagnosed with hydramnios and breech presentation while in early labor is diagnosed with early postpartum hemorrhage at 1 hour after a cesarean birth. The client asks, “Why am I bleeding so much?” The nurse responds based on the understanding that the most likely cause of uterine atony in this client is which of the following? a. Lengthy and prolonged second stage of labor b. Trauma during labor and birth c. Overdistention of the uterus from hydramnios d. Moderate fundal massage after birth 27. A client is admitted to the birthing unit in active labor. Cervical dilation has progressed from 2 to 3 cm during an 8- hour period. The health care provider determines that she has hypotonic dystocia, and an infusion of oxytocin (Pitocin) is prescribed to augment her contractions. What is the most important nursing action at this time? a. Checking the perineum for bulging b. Monitoring the duration and intensity of the contractions c. Preparing the client for an emergency cesarean birth d. Documenting the fetal heart rate and its variations28. A client at 38 weeks’ gestation is admitted for induction of labor. Her membranes ruptured 12 hours ago. There are no other signs of labor. Which medication does the nurse anticipate will be prescribed? a. Oxytocin (Pitocin) b. Progesterone (Prometrium) c. Estrogen (Premarin) d. Ergonovine (Ergotrate) 29. A client arrives at the clinic in preterm labor and terbutaline (Brethine) is prescribed. For what therapeutic effect should the nurse monitor the client? a. Increased blood pressure and pulse b. Decreased frequency and duration of contractions c. Gradual cervical dilation as labor progresses d. Reduction of pain in the perineal area 30. Despite medication, a client’s preterm labor continues, her cervix dilates, and birth appears to be inevitable. Which medication does the nurse anticipate will be prescribed to increase the chance of the newborn’s survival? a. Misoprostil (Cytotec) b. Ritodrine (Yutopar) c. Terbutaline (Brethine) d. Betamethasone (Celestone) 31. A client tells a nurse that she does not want an episiotomy and would rather tear naturally. What information should be offered regarding each birthing method? a. Lacerations are more painful than an episiotomy b. Lacerations are easier to repair than an episiotomy c. An episiotomy is preferred over lacerations according to evidence-based practice d. An episiotomy causes less posterior trauma than lacerations 32. A client who had a postpartum hemorrhage is to receive 1 unit of packed red blood cells (RBCs). The nurse manager observes a staff nurse administering the packed RBCs without wearing gloves. What does the nurse manager conclude? a. Nurse was skilled enough to prevent exposure to the blood b. Client does not have an infection.c. Nurse should have worn gloves for self-protection d. Donor blood is free of bloodborne pathogens 33. Sitz baths are ordered for a client with an episiotomy during the postpartum period. A nurse encourages her to take the sitz baths because they aid the healing process by: a. promoting vasodilation. b. tightening the rectal sphincter c. softening the incision site. d. cleansing perineal tissue 34. An infant is born precipitously in the emergency department. What should the nurse do first? a. Ascertain the condition of the uterine fundus b. Tie and cut the umbilical cord. c. Establish an airway for the newborn d. Arrange transport for mother and infant to the birthing unit. 35. A nurse in the birthing unit is caring for several clients. Which factor should the nurse anticipate will increase then risk for hypotonic uterine dystocia? a. Twin gestation b. Gestational hypertension c. Gestational anemia d. Hypertonic contractions 36. A nurse is counseling a client who is experiencing preterm contractions in the 35th week of gestation and whose cervix is dilated 2 cm. What should the nurse teach this client about sexual intercourse at this time? a. Is permitted as long as penile penetration is shallow b. Should be restricted to the side-lying position c. Is prohibited because it may stimulate labor d. Should be limited to once a week37. A multigravid client at 39 weeks' gestation diagnosed with insulin-dependent diabetes is admitted for induction of labor with oxytocin. Which of the following should the nurse include in the teaching plan as a possible disadvantage of this procedure? a. Maternal hypoglycemia b. Neonatal jaundice. c. Urinary frequency. d. Preterm birth 38. A client pregnant with twins is told by the health care provider that she is at risk for postpartum hemorrhage. Later, the client asks the nurse why she is at risk for hemorrhage. What should the nurse consider is the cause of the postpartum hemorrhage before responding in language the client will understand? a. Mediolateral episiotomy b. Uterine atony c. Lacerations of the cervix d. Retained placental fragments 39. A client in labor at 39 weeks’ gestation is told by the health care provider that she will need a cesarean birth. The nurse reviews the client’s prenatal history. What preexisting condition is the most likely reason for the cesarean birth? a. Gonorrhea b. Active genital herpes c. Chlamydia d. Chronic hepatitis 40. A nurse in the birthing suite has just admitted four clients. Which client should the nurse anticipate will need to be prepared for a cesarean birth? a. Multipara with a shoulder presentation b. Primigravida with a twin gestation with the lowermost in the vertex presentation c. Multipara with a documented station of “floating” d. Primigravida with a fetus presenting in the occiput posterior41. During the first hour after a cesarean birth, a nurse observes that the client’s lochia has saturated one perineal pad. Based on the knowledge of expected lochial flow, what should the nurse conclude that this indicates? a. Retained placental fragments b. Postpartum hemorrhage c. Lochial flow within expected limits d. Scant lochial flow 42. What is the safest position for a woman in labor when a nurse observes a prolapsed cord? a. Lithotomy b. Trendelenburg c. Fowler d. Prone 43. After a precipitous delivery, the nurse notes that the new mother is passive and only touches her newborn infant briefly with her fingertips. What should the nurse do to help the woman process the delivery? a. Support the mother in her reaction to the newborn infant. b. Encourage the mother to breast-feed soon after birth. c. Document a complete account of the mother’s reaction on the birth record. d. Tell the mother that it is important to hold the newborn infant 44. The nurse in a labor room is monitoring a client with dysfunctional labor for signs of fetal or maternal compromise. Which assessment finding would alert the nurse to a compromise? a. Persistent nonreassuring fetal heart rate b. Maternal fatigue c. Coordinated uterine contractions d. Progressive changes in the cervix 45. The nurse in a labor room is preparing to care for a client with hypertonic uterine contractions. The nurse is told that the client is experiencing uncoordinated contractions that are erratic in their frequency, duration, and intensity. What is the priority nursing action? a. Promote ambulation every 30 minutes b. Prepare the client for an amniotomyc. Provide pain relief measures.