NUR411 Exam 1 Part 3

1.

1 point

A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. The nurse's best response is:

"Labor is scary to think about, but the actual experience isn't."

"It's normal to be anxious about labor. Let's discuss what makes you afraid."

"Don't worry about it. You'll do fine."

"You may have an epidural. You won't feel anything."

2.

1 point

If a woman complains of back labor pain, the nurse might best suggest that she:

Take some deep, cleansing breaths

Do less walking around

Lean over a birth ball with her knees on the floor

Lie on her back for a while with her knees bent

3.

1 point

A nurse is providing care to a woman 38 weeks pregnant. During the most recent vaginal examination, the nurse notes that the cervix is 6 cm dilated, 100% effaced, with the vertex at -1 station. What is the best interpretation?

Latent phase with the backside as presenting part, fully engaged

Active labor with the head as presenting part, fully engaged

Transition phase with the backside as presenting part, fully engaged

Active labor with the head as presenting part, not yet engaged

4.

1 point

With regard to spinal and epidural (block) anesthesia, nurses should know that:

Spinal and epidural blocks are never used together

Epidural blocks allow the woman to move freely

This type of anesthesia is commonly used for cesarean births but is not suitable for vaginal births

A high incidence of postbirth headache is seen with spinal blocks

5.

1 point

A woman with a term, uncomplicated pregnancy comes into L&D in early labor saying that she thinks her water broke. Which action should the nurse take?

Collect sample of fluid for microbial analysis

Immediately contact doctor

Prep the woman for delivery

Note color, amount, and odor of fluid

6.

1 point

A woman is experiencing back labor and complains of intense pain in her lower back. An effective relief measure is to use:

Counterpressure against the sacrum

Effleurage

Biofeedback

Pant-blow (breaths and puffs) breathing techniques

7.

1 point

With regard to primary and secondary powers, the maternity nurse should understand that:

Primary powers are responsible for effacement and dilation of the cervix

Scarring of the cervix caused by a previous infection or surgery may make the delivery a bit more painful, but it should not slow or inhibit dilation

Effacement generally is well ahead of dilation in women giving birth for the first time; they are more together in subsequent pregnancies

Pushing in the second stage of labor is more effective if the woman can breathe deeply and control some of her involuntary needs to push, as the nurse directs

8.

1 point

(True/false) Systemic analgesia crosses the blood-brain barrier and placental barrier.

True

False

9.

1 point

Which of the following is a primary concern if the membranes rupture more than 24 hours before delivery?

Infection

Respiratory distress

Stillbirth

Cerebral Palsy

10.

1 point

Nitrous oxide is commonly used as an inhalation agent for obstetrics in the United States.

True

False

11.

1 point

The ___ theory involves blocking pain impulses by providing other messages (distractions) to be sent; pain cannot be transmitted down the pathway at the same time.

Referred Pain

Gate-control

Visceral Pain

Controlled-Pain

12.

1 point

A woman is completely dilated and at a +2 station. Her contractions are strong and last 50-70 seconds. Based on this information, the nurse should know that the patient is in which stage of labor?

2nd

4th

3rd

1st

13.

1 point

When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. These measures include:

Continuing an epidural anesthetic so that pain is reduced and the woman can relax

Encouraging the woman to try various upright positions, including squatting and standing

Coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction

Telling the woman to start pushing as soon as her cervix is fully dilated

14.

1 point

The nurse is developing a teaching plan for a patient who is 8 weeks pregnant. The nurse should tell the patient that she can expect to feel the fetus move at which time?

Between 16 and 20 weeks' gestation

Between 12 and 14 weeks' gestation

Between 10 and 12 weeks' gestation

Between 21 and 23 weeks' gestation

15.

1 point

After performing Leopold's maneuvers on a patient in labor, the nurse should prepared the patient for a vaginal delivery after determining if the fetus is in which of the following positions?

Transverse lie

Vertex presentation

Face presentations

Oblique lie

16.

1 point

What term is associated with the system used to determine the position of the fetus inside the uterus?

Braxton-Hicks maneuvers

Nuchal translucency maneuvers

Leopold's Manuever

Amadeus maneuvers

17.

1 point

Which of the following nursing actions is required before a client in labor receives an epidural?

Assess maternal reflexes

Assess maternal gait

Give a bolus of fluid

Check for maternal pupil dilation

18.

1 point

Which test is performed to determine if membranes are ruptured?

AROM

Urine analysis

Fern test

Leopold Maneuvers

19.

1 point

A nurse teaches a pregnant woman about the characteristics of true labor contractions. The nurse evaluates her understanding of the instructions when the woman states:

"True labor contractions will remain irregular but become stronger."

"True labor contractions will subside when I walk around."

"True labor contractions will continue and get stronger even if I relax and take a shower."

"True labor contractions will cause discomfort over the top of my uterus."