MSITX - LABOR AND DELIVERY OBGYN EXAM

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LABOR AND DELIVERY OBGYN EXAM

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1. Allison is in active labor and begins breathing rapidly. She complains of tingling and numbness in her hands and feet. All of the following might be helpful EXCEPT: *	a) Taking slow even breaths b) Rubbing her hands and feet c) Breathing into a paper bag d) Cupping hands over nose and mouth
2. Mrs. K is experiencing her third pre-term labor. The usual initial treatment for her is: *	a. Bed rest on left side b) Diet and fluids c) Ethanol drip d) Oxytocin
3. Calcium gluconate is readily available for the pre-eclamptic or eclamptic patient because it: *	a) Reverses respiratory depression and heart block b) Relaxes the eclamptic patient preventing convulsions c) Acts as a CNS depressant controlling convulsions d) Encourages lowering of blood pressure
4. Mary has a fever of 101 degrees F. when she is admitted in labor. Her membranes have been ruptured for 10 hours. A symptom you might expect with this situation would be: *	a) Vaginal bleeding b) Fetal tachycardia c) Hypotension d) Hyperreflexia
5. In providing labor support for Ms. Jones, G II P I, age 35, your assessment includes the following: BP 160/100, edema of face and extremities, epigastric pain and hyperreflecia. What intervention would be appropriate: *	a) Vital signs every 2 hours-low sodium diet-good light and support systems available b) Give calcium gluconate-monitor reflexes and monitor VS every 1 hour-limit visitors c) Dim lights-airway and 02 at bedside-padded side rails and strict intake and output d) Administer sedative-check urine for albumin-decrease fluid intake and give an antacid
6. Mrs. Jones condition worsens and she is at risk for: *	a) Severe nausea and vomiting b) Dehydration c) Congestive heart failure d) Convulsions
7. You are administering IV MgS04 to Mrs. Jones with severe pre-eclampsia. You assess her and find respirations 12 - DTRs (deep tendon reflexes) absent and urine output for the past 4 hours is 90 ml. What would you do: *	a) Administer calcium gluconate immediately b) Administer only half the dose of MgS04 c) Continue the MgS04 d) Stop the MgS04 and notify the doctor
8. Ms. Gabore is in labor. Meconium stained drainage is evident vaginally after a routine exam. This indicates: *	a) A vertex presentation b) A baby with multiple anomalies c) A signal to watch for distress in the fetus and newborn d) The need for ultrasound to diagnose prolapse of cord
9. Brenda is Gravida 1 and dilated to 7-8 cms. She had no prenatal education and is losing control during contractions. The most appropriate NURSING intervention would be: *	a) Teach progressive relaxation techniques b) Give Demerol 50 mg-IV slowly c) Use touch-presence-focusing d) Remind her she is jeopardizing the baby's health
10. Ms. Vane was urged to void frequently during labor because: *	a) It will take too long to empty the bladder during delivery b) Labor may be slowed by an over-distended bladder c) A urine specimen must be obtained at intervals d) There is too much danger of infection following a catheterization
11. After administering Meperidine Hydrochloride to a laboring patient- you should: *	a) Assess maternal vital signs and the FHR frequently b) Assess cervical dilation every 30 minutes c) Turn off the light-close the door and allow the patient to sleep for a while d) Tell the patient that you will not be able to give her anything else because the baby's vital signs may become depressed
12. The forces responsible for the expulsion of the fetus and placenta are: *	a) Involuntary uterine contractions b) Voluntary efforts of abdominal and diaphragmatic muscles c) Contractions of the levator ani muscles d) All of the above
13. Ms. Baxley has the internal monitor applied. You note the fetal heart rate at 70 at the end of the contraction. Your nursing actions should be: *	a) Increase uterine activity-give analgesia and catheterize for distended bladder b) Prepare for operative delivery by shaving abdomen-placing foley catheter and calling anesthesia c) Change position to knee/chest-apply 02 by mask and slow IV fluids d) Change position to left side-give 02 by mask and increase IV fluids
14. Which of the following nursing actions is NOT appropriate when caring for a patient on a pitocin infusion for augmentation of labor: *	a) The nurse sets up the pitocin infusion in a piggyback IV line and inserts it at the most proximal junction to the patient b) The nurse increases the rate of administration according to contraction pattern c) The nurse begins the infusion monitors the patient's status continuously for 15 minutes then records VS - FHT and contractions every 30 minutes
15. Wendy Day is pregnant again. She has a 4 year old at home- had premature twins (34 eweks gestation) 2 years ago that died 2 days after birth and had a spontaneous abortion at 12 weeks gestation 1 year ago. She is correctly classified as: *	a) Gravida IV para 1 b) Gravida IV para II c) Gravida III para I d) Gravida IV para III
16. The onset of labor is said to start when the musculature of the uterus starts: *	a) Painful contractions and brings about the start of cervical effacement b) Regular pronounced contractions and brings about the progressive cervical effacement and dilation of the cervix c) Regular uterine contractions and brings about effacement of the cervix d) Contractions which brings about some effacement and descent of the cervix
17. When doing a pelvic exam to check for fetal position you note the diamond shaped fontanels are posterior and you follow the parietal suture lines to the right, the position of teh presenting part is: *	a) LOT b) LOA c) ROP d) ROA
18. Mrs Ashford is Gravida II and she is in the active phase of the first stage of labor. She is dilated 6 cm and she is crying with pain. She has Demerol 75 mg every 3 hours PRN ordered. The FHT rate is 130 - the nurse should: *	a) Administer the Demerol as ordered b) Call the physician and inform him of the patient's status c) Withholod the medication and check the patient again in 30 minutes d) Administer a smaller amount of Demerol
19. Mrs. Smith- a Gravida II Para II is dilated to 6 cm- effaced C and at 0 station. On a vaginal exam you note the position of the presenting part to be LOP. Mrs. Smith has been given 25 mg of Demerol IV push for pain but is still very uncomfortable. *	a) Position patient on back with ice to her back b) Position patient sitting up and tell her the pain will decrease when the medication takes effect c) Position patient on her side and give abdominal support and warm compresses to back d) Position patient on her side and give deep back massage with cold compress
20. You walk into the labor room and Mrs. Jones is pushing. She states she can't help it- the baby is coming. You look under the cover and see the head on the perineum. Your FIRST nursing action would be: *	a) Go call physician to deliver baby b) Check for cord around the neck c) Suction nose and mouth as you deliver head d) Apply fingers to guide head out
21. The nurse can assist the mother during the second stage of labor by all of the following EXCEPT: *	a) Position in the C-position - head supported on chest b) Position legs in flexed position c) Assist mother to work with the urge to push d) Position the mother supine with legs flexed and thighs on abdomen
22. In the first minute after birth you are doing an apgar assessment of the newborn. The heart rate is 110, respirations are regular, infant is crying. Some flexion of extremities is present, the infant sneezes with the insertion of a bulb syringe and *	a) 8 b) 7 c) 6 d) 9
23, The single most important factor is preventing and controlling infections in the nursery is: *	a) Prophylactic administration of antibiotics to all infants in the nursery b) Bathing all babies with phisohex daily c) Meticulous hand washing by the staff d) Damp dusting nursery surfaces with a strong antiseptic
24. Mrs. Thompson is a Gravida IV para IV. While assessing her fundus 1 hour after delivery you find that it is enlarged and soft. What would be your FIRST nursing intervention: *	a) Take her vital signs and report to the physician b) Administer the PRN order for the oxytocin drug - Methergine c) Massage the uterus firmly with one hand and support the other d) Continue to check the consistency of her fundus at 15 minute intervals
25. Carrie is complaining of pain in the rectal area. On inspection you notice the area has increased in size. He vital signs are blood pressure 100/70- pulse 90- respirations 20. She is experiencing a hematoma. What should you do NOW: *	a) Give medication for pain relief b) Report symptoms to physician c) Give Pitocin order received d) Pack area with ice and cover with sterile gauze
26. The fetal heart rate usually lies within which range: *	a) 200 - 240 b) 100 - 160 c) 120 - 160 d) 80 - 120
27. Of the following- which has been linked to cigarette smoking during pregnancy: *	a) Down's Syndrome b) Increased placental permeability c) Erythroblastosis d) Vasoconstriction of placental vessels and fetal growth retardation
28. Mrs. Jackson is to have an oxytocin challenge test this afternoon. What does this test evaluate: *	a) Placental sufficiency b) Uterine contractibility c) Fetal maturity d) Ability of mother to have a vaginal delivery
29. Which of the following would not contraindicate the application of a spiral electrode to monitor the fetus: *	a) Breech presentation b) Meconium stained fluid c) Herpes simplex virus in mother d) A and b
30. Before performing the Leopold maneuver to determine fetal position the nurse should make certain that the patient: *	a) Has had a vaginal exam b) Has not eaten one hour prior to the exam c) Has had an enema d) Has emptied her bladder
31. Mrs. Johns is a 24 year old primi gravida at term. On vaginal exam - the cervix is 100% effaced- 5 cm dilated- the vertex is at +1 station. According to the above data- Mrs. Johns is in: *	a) 1st stage of labor/active phase b) 1st stage of labor/transition phase c) 3rd stage of labor d) 1st stage of labor/accelerated phase
32. A few hours later Mrs. Johns becomes restless- her face is flushed and she feels she is going to vomit. This indicates: *	a) 2nd stage of labor b) Transisition phase of labor c) 3rd stage of labor d) 1st stage of labor - accelerated phase
33. As a nurse in the Labor and Delivery Unit you receive calls from pregnant women near term. You would advise the term patient to call her physician immediately if she has described which of the following: *	a) Painless vaginal bleeding b) Blood streaked mucus c) Constipation d) Intermittent mild uterine contractions
34. Following rupture of the amniotic sac the nurse in the labor room should immediately: *	a) Take the mother's vital signs b) Administer oxygen to the mother by nasal cannula c) Check fetal heart tones d) Call the physician
35. Which of the following indicates the end of the first stage of labor: *	a) The cervix is completely effaced and dilated b) The presenting part is visible during contractions c) The anmiotic sac has been ruptured and is draining d) There are regular three minute contractions
36. Bulging of the perineum is a sign of: *	a) Imminent delivery b) Shoulder presentation c) Breech presentation d) Difficult delivery
37. The patient in labor is encouraged to push with contractions. *	a) During 1st stage of laborb) during transition phasec) During 3rd stage of labord) During 2nd stage of labor
38. Mrs. Ledbetter is a Gravida II para II. Her infant weighed 7 lbs 14 oz and was delivered by forceps over a midline episiotomy. Which of the following observations should be reported to the physician: *	a) Mother's pulse rate 90 to 100 b) Fundus firm in midline c) Steady - small trickle of bright red blood from the vagina d) Fundus just below the level of umbilicus
39. IMMEDIATE care of the newborn following delivery includes: *	a) Cleaning vernix from baby's body b) Warming and drying the infant c) Bandaging the cord stump with adaptic gauze d) Administration of silver nitrate eye drops
40. Mrs. Jackson completed prepared child birth classes. She is now in labor with contractions 2 minutes apart- cervix dilated 8 cm. To assist her with breathing patterns during this period you would remind her to: *	a) Deep breathe throughout the contraction then resume shallow chest breathing b) Shallow chest breathing-accelerate as contraction intensifies - decelerate as contraction subsides c) Slow chest breathing 6-9 min. Inhale through nose - exhale through mouth d) Breathe in pattern that is most comfortable and helpful but not to hyperventilate
41. Mrs. Hurst has received an analgesic through an epidural catheter. Her blood pressure has suddenly dropped from 130/80 to 80/50. Appropriate nursing action would include: *	a) Placing the patient in Trendelenburg and increase the IV rate of D5RL b) Turning the patient to her left side and increasing the IV rate c) No nursing action is indicated as this is a normal response to full epidural dose d) Administer oxygen in mask at 5L/min - place patient supine
42. Your patient is on a fetal monitor. You note that there are accelerations of fetal heart rate with uterine contractions. Your action should be to: *	a) Prepare for emergency C-Section because of fetal distress from cord compression b) Allow the patient to walk the halls to hasten labor process c) continue care and monitoring because this is healthy fetal response to stimulation d) Call the physician because this is an abnormal fetal response to stimulation
43. When a pre-eclamptic patient is receiving magnesium sulfate - it is essential for the nurse to monitor for signs and symptoms of drug toxicity such as: *	a) Urinary output less than 100ml in 4 hours b) Increased patellar reflex c) Epigastric pain d) Blood pressure less than 120/70
44. Two hours post partum you check Mrs. Laws. Her fundus is displaced to the left side of her abdomen with moderate rubra lochia. Your FIRST action should be: *	a) Have the patient void - catheterize if necessary b) Report findings to the physician c) Check patient's vital signs d) Start an IV with pitocin
45. You would anticipate administration of Rho-gam to: *	a) RH+ mother; RH- infant b) RH- mother; RH- infant c) RH- mother; RH+ infant d) RH+ mother; RH+ infant