maternal and child healthe nursing MCQ 6

1.     A woman in her 40th week of pregnancy calls the nurse at the clinic and says she's not sure whether she is in true or false labor. Which statement by the client would lead the nurse to suspect that the woman is experiencing false labor?
a) "I'm feeling contractions mostly in my back."
b) "My contractions are about 6 minutes apart and regular."
c) "The contractions slow down when I walk around."
d) "If I try to talk to my partner during a contraction, I can't."

ANS; C
False labor is characterized by contractions that are irregular and weak, often slowing down with walking or a position change. True labor contractions begin in the back and radiate around toward the front of the abdomen. They are regular and become stronger over time; the woman may find it extremely difficult if not impossible to have a conversation during a contraction.

2.   Which of the following would indicate to the nurse that the placenta is separating?
A) Uterus becomes globular
B) Fetal head at vaginal opening
C) Umbilical cord shortens
D) Mucous plug is expelled

ANS; A
Placental separation is indicated by the uterus changing shape to globular and upward rising of the uterus. Additional signs include a sudden trickle of blood from the vaginal opening, and lengthening (not shortening) of the umbilical cord. The fetal head at the vaginal opening is termed crowning and occurs before birth of the head. Expulsion of the mucous plug is a premonitory sign of labor.

3.   When assessing cervical effacement of a client in labor, the nurse assesses which of the following characteristics?

A) Extent of opening to its widest diameter
B) Degree of thinning
C) Passage of the mucous plug
D) Fetal presenting part

ANS; B
Effacement refers to the degree of thinning of the cervix. Cervical dilation refers to the extent of opening at the widest diameter. Passage of the mucous plug occurs with bloody show as a premonitory sign of labor. The fetal presenting part is determined by vaginal examination and is commonly the head (cephalic), pelvis (breech), or shoulder.

4.   A woman calls the health care facility stating that she is in labor. The nurse would urge the client to come to the facility if the client reports which of the following?

A) Increased energy level with alternating strong and weak contractions
B) Moderately strong contractions every 4 minutes, lasting about 1 minute
C) Contractions noted in the front of abdomen that stop when she walks
D) Pink-tinged vaginal secretions and irregular contractions lasting about 30 seconds

ANS; B
Moderately strong regular contractions 60 seconds in duration indicate that the client is probably in the active phase of the first stage of labor. Alternating strong and weak contractions, contractions in the front of the abdomen that change with activity, and pink-tinged secretions with irregular contractions suggest false labor.

5.    A woman is in the first stage of labor. The nurse would encourage her to assume which position to facilitate the progress of labor?

A) Supine
B) Lithotomy
C) Upright
D) Knee-chest

ANS; C
The use of any upright position helps to reduce the length of labor. Research validates that nonmoving back-lying positions such as supine and lithotomy positions during labor are not healthy. The knee-chest position would assist in rotating the fetus in a posterior position.

6.   A client has not received any medication during her labor. She is having frequent contractions every 1 to 2 minutes and has become irritable with her coach and no longer will allow the nurse to palpate her fundus during contractions. Her cervix is 8 cm dilated and 90% effaced. The nurse interprets these findings as indicating:

A) Latent phase of the first stage of labor
B) Active phase of the first stage of labor
C) Transition phase of the first stage of labor
D) Pelvic phase of the second stage of labor

 

7.    The fetus of a nulliparous woman is in a shoulder presentation. The nurse would most likely prepare the client for which type of birth?

A) Cesarean
B) Vaginal
C) Forceps-assisted
D) Vacuum extraction

ANS; A
The fetus is in a transverse lie with the shoulder as the presenting part, necessitating a cesarean birth. Vaginal birth, forceps-assisted, and vacuum extraction births are not appropriate.

 

8.   Assessment of a woman in labor reveals cervical dilation of 3 cm, cervical effacement of 30%, and contractions occurring every 7 to 8 minutes, lasting about 40 seconds. The nurse determines that this client is in:

A) Latent phase of the first stage
B) Active phase of the first stage
C) Transition phase of the first stage
D) Perineal phase of the second stage

 

ANS; A
The latent phase of the first stage of labor involves cervical dilation of 0 to 3 cm, cervical effacement of 0% to 40%, and contractions every 5 to 10 minutes lasting 30 to 45 seconds. The active phase is characterized by cervical dilation of 4 to 7 cm, effacement of 40% to 80%, and contractions occurring every 2 to 5 minutes lasting 45 to 60 seconds. The transition phase is characterized by cervical dilation of 8 to 10 cm, effacement of 80% to 100%, and contractions occurring every 1 to 2 minutes lasting 60 to 90 seconds. The perineal phase of the second stage occurs with complete cervical dilation and effacement, contractions occurring every 2 to 3 minutes and lasting 60 to 90 seconds, and a tremendous urge to push by the mother.

 

9.   A client is admitted to the labor and birthing suite in early labor. On review of her medical record, the nurse determines that the client's pelvic shape as identified in the antepartal progress notes is the most favorable one for a vaginal delivery. Which pelvic shape would the nurse have noted?

A) Platypelloid
B) Gynecoid
C) Android
D) Anthropoid

 

ANS; B
The most favorable pelvic shape for vaginal delivery is the gynecoid shape. The anthropoid pelvis is favorable for vaginal birth but it is not the most favorable shape. The android pelvis is not considered favorable for a vaginal birth because descent of the fetal head is slow and failure of the fetus to rotate is common. Women with a platypelloid pelvis usually require cesarean birth.

 

10.                      A woman telephones her health care provider and reports that her waters just broke. Which suggestion by the nurse would be most appropriate?

A) "Call us back when you start having contractions."
B) "Come to the clinic or emergency department for an evaluation."
C) "Drink 3 to 4 glasses of water and lie down."
D) "Come in as soon as you feel the urge to push."

 

ANS; B
When the amniotic sac ruptures, the barrier to infection is gone and there is the danger of cord prolapse if engagement has not occurred. Therefore, the nurse should suggest that the woman come in for an evaluation. Calling back when contractions start, drinking water, and lying down are inappropriate because of the increased risk for infection and cord prolapse. Telling the client to wait until she feels the urge to push is inappropriate because this occurs during the second stage of labor.

11.After teaching a group of students about the maternal bony pelvis, which statement by the group indicates that the teaching was successful?

A) The bony pelvis plays a lesser role during labor than soft tissue.
B) The pelvic outlet is associated with the true pelvis.
C) The false pelvis lies below the imaginary linea terminalis.
D) The false pelvis is the passageway through which the fetus travels.

ANS; B
The maternal bony pelvis consists of the true and false portions. The true pelvis is made up of three planes—the inlet, the mid pelvis, and the outlet. The bony pelvis is more important part of the passageway because it is relatively unyielding. The false pelvis lies above the imaginary linea terminalis. The true pelvis is the bony passageway through which the fetus must travel.

12.                       A fetus is assessed at 2 cm above the ischial spines. The nurse would document fetal station as:

A) +4
B) +2
C) 0
D) -2

ANS; D
When the presenting part is above the ischial spines, it is noted as a negative station. Since the measurement is 2 cm, the station would be -2. A 0 station indicates that the fetal presenting part is at the level of the ischial spines. Positive stations indicate that the presenting part is below the level of the ischial spines.

13.                       Assessment of a fetus identifies the buttocks as the presenting part, with the legs extended upward. The nurse identifies this as which type of breech presentation?

A) Frank
B) Full
C) Complete
D) Footling

ANS; A
In a frank breech, the buttocks present first, with both legs extended up toward the face. In a full or complete breech, the fetus sits cross-legged above the cervix. In a footling breech, one or both legs are presenting.

14.                       A woman in labor who received an opioid for pain relief develops respiratory depression. The nurse would expect which agent to be administered?

A) Butorphanol
B) Fentanyl
C) Naloxone
D) Promethazine

ANS;C
Naloxone is an opioid antagonist used to reverse the effects of opioids such as respiratory depression. Butorphanol and fentanyl are opioids and would cause further respiratory depression. Promethazine is an ataractic used as an adjunct to potentiate the effectiveness of the opioid.

15.                       A client's membranes spontaneously ruptured, as evidenced by a gush of clear fluid with a contraction. Which of the following would the nurse do next?

A) Check the fetal heart rate.
B) Perform a vaginal exam.
C) Notify the physician immediately.
D) Change the linen saver pad

 

ANS; A
When membranes rupture, the priority focus is on assessing fetal heart rate first to identify a deceleration, which might indicate cord compression secondary to cord prolapse. A vaginal exam may be done later to evaluate for continued progression of labor. The physician should be notified, but this is not a priority at this time. Changing the linen saver pad would be appropriate once the fetal status is determined and the physician has been notified.

16.                       A woman has just entered the second stage of labor. The nurse would focus care on which of the following?

A) Encouraging the woman to push when she has a strong desire to do so
B) Alleviating perineal discomfort with the application of ice packs
C) Palpating the woman's fundus for position and firmness
D) Completing the identification process of the newborn with the mother

 

ANS; A
During the second stage of labor, nursing interventions focus on motivating the woman, encouraging her to put all her efforts toward pushing. Alleviating perineal discomfort with ice packs and palpating the woman's fundus would be appropriate during the fourth stage of labor. Completing the newborn identification process would be appropriate during the third stage of labor.

 

17.                       The nurse notes persistent early decelerations on the fetal monitoring strip. Which of the following would the nurse do next?

A) Continue to monitor the FHR because this pattern is benign.
B) Perform a vaginal exam to assess cervical dilation and effacement.
C) Stay with the client while reporting the finding to the physician.
D) Administer oxygen after turning the client on her left side.

 

ANS; A
Early decelerations are not indicative of fetal distress and do not require intervention. Therefore, the nurse would continue to monitor the fetal heart rate pattern. There is no need to perform a vaginal exam, report the finding to the physician, or administer oxygen.

18.                      A woman is admitted to the labor and birthing suite. Vaginal examination reveals that the presenting part is approximately 2 cm above the ischial spines. The nurse documents this finding as:

A) +2 station
B) 0 station
C) -2 station
D) Crowning

ANS; C
The ischial spines serve as landmarks and are designated as zero status. If the presenting part is palpated higher than the maternal ischial spines, a negative number is assigned. Therefore, the nurse would document the finding as -2 station. If the presenting part is below the ischial spines, then the station would be +2. Crowning refers to the appearance of the fetal head at the vaginal opening.

19.                       The nurse is performing Leopold's maneuvers to determine fetal presentation, position, and lie. Which action would the nurse do first?

A) Feel for the fetal buttocks or head while palpating the abdomen.
B) Feel for the fetal back and limbs as the hands move laterally on the abdomen.
C) Palpate for the presenting part in the area just above the symphysis pubis.
D) Determine flexion by pressing downward toward the symphysis pubis.

ANS;

A
The first maneuver involves feeling for the buttocks and head . Next the nurse palpates on which side the fetal back is located. The third maneuver determines presentation and involves palpating the area just above the symphysis pubis. The final maneuver determines attitude and involves applying downward pressure in the direction of the symphysis pubis

20.                     7. A client states, "I think my waters broke! I felt this gush of fluid between my legs." The nurse tests the fluid with Nitrazine paper and confirms membrane rupture if the paper turns:

A) Yellow
B) Olive green
C) Pink
D) Blue

ANS;D
Amniotic fluid is alkaline and turns Nitrazine paper blue. Nitrazine paper that remains yellow to olive green suggests that the membranes are most likely intact.

21.                       A woman in labor is to receive continuous internal electronic fetal monitoring. The nurse understands that which of the following must be present?

A) Intact membranes
B) Cervical dilation of 2 cm or more
C) Floating presenting fetal part
D) A neonatologist to insert the electrode

ANS; B
For continuous internal electronic fetal monitoring, four criteria must be met: ruptured membranes, cervical dilation of at least 2 cm, fetal presenting part low enough to allow placement of the electrode, and a skilled practitioner available to insert the electrode.

 

22.                     When assessing fetal heart rate, the nurse finds a heart rate of 175 bpm, accompanied by a decrease in variability and late decelerations. Which of the following would the nurse do next?

A) Have the woman change her position.
B) Administer oxygen.
C) Notify the health care provider.
D) Continue to monitor the pattern every 15 minutes

ANS; C
Fetal tachycardia as evidenced by a fetal heart rate greater than 160 bpm accompanied by a decrease in variability and late decelerations is an ominous sign indicating the need for prompt intervention. The health care provider should be notified immediately and then measures should be instituted such as having the woman lie on her side and administering oxygen. In this instance, monitoring should be continuous to detect any further changes and evaluate the effectiveness of interventions.

 

23.                     A woman in labor has chosen to use hydrotherapy as a method of pain relief. Which statement by the woman would lead the nurse to suspect that the woman needs additional teaching?

A) "The warmth and buoyancy of the water has a nice relaxing effect."
B) "I can stay in the bath for as long as I feel comfortable."
C) "My cervix should be dilated more than 5 cm before I try using this method."
D) "The temperature of the water should be at least 105 degrees F."

 

ANS; D
Hydrotherapy is an effective pain relief method. The water temperature should not exceed body temperature. Therefore, a temperature of 105 degrees would be too warm. The warmth and buoyancy have a relaxing effect and women are encouraged to stay in the bath as long as they feel comfortable. The woman should be in active labor with cervical dilation greater than 5 cm.

 

24.                     A woman in labor received an opioid close to the time of birth. The nurse would assess the newborn for which of the following?

A) Respiratory depression
B) Urinary retention
C) Abdominal distention
D) Hyperreflexia

 

 

ANS; A
Opioids given close to the time of birth can cause central nervous system depression, including respiratory depression, in the newborn, necessitating the administration of naloxone. Urinary retention may occur in the woman who received neuraxial opioids. Abdominal distention is not associated with opioid administration. Hyporeflexia would be more commonly associated with central nervous system depression due to opioids.

 

 

25.                      When applying the ultrasound transducers for continuous external electronic fetal monitoring, at which location would the nurse place the transducer to record the FHR?

A) Over the uterine fundus where contractions are most intense
B) Above the umbilicus toward the right side of the diaphragm
C) Between the umbilicus and the symphysis pubis
D) Between the xiphoid process and umbilicus

ANS; C
The ultrasound transducer is positioned on the maternal abdomen in the midline between the umbilicus and the symphysis pubis. The tocotransducer is placed over the uterine fundus in the area of greatest contractility.

26.                     After describing continuous electronic fetal monitoring to a laboring woman and her partner, which of the following would indicate the need for additional teaching?

A) "This type of monitoring is the most accurate method for our baby."
B) "Unfortunately, I'm going to have to stay quite still in bed while it is in place."
C) "This type of monitoring can only be used after my membranes rupture."
D) "You'll be inserting a special electrode into my baby's scalp."

 

ANS;B
With continuous internal electronic monitoring, maternal position changes and movement do not interfere with the quality of the tracing. Continuous internal monitoring is considered the most accurate method, but it can be used only if certain criteria are met, such as rupture of membranes. A spiral electrode is inserted into the fetal presenting part, usually the head.

 

27.                      When planning the care of a woman in the active phase of labor, the nurse would anticipate assessing the fetal heart rate at which interval?

A) Every 4 hours
B) Every 60 minutes
C) Every 30 minutes
D) Every 15 minutes

 

ANS; C
During the active phase of labor, FHR is monitored every 30 minutes. The woman's temperature is typically assessed every 4 hours during the first stage of labor. Contractions and vital signs are monitored every 30 to 60 minutes during the latent phase; contractions are assessed every 15 minutes during the transition phase.

 

28.                     Which of the following is a priority when caring for a woman during the fourth stage of labor?

A) Assessing the uterine fundus
B) Offering fluids as indicated
C) Encouraging the woman to void
D) Assisting with perineal care

 

ANS; A
During the fourth stage of labor, a priority is to assess the woman's fundus to prevent postpartum hemorrhage. Offering fluids, encouraging voiding, and assisting with perineal care are important but not an immediate priority.

 

29.                     When palpating the fundus during a contraction, the nurse notes that is feels like a chin. The nurse interprets this finding as indicating which type of contraction?

A) Intense
B) Strong
C) Moderate
D) Mild

ANS; C
A contraction that feels like the chin typically represents a moderate contraction. A contraction described as feeling like the tip of the nose indicates a mild contraction. A strong contraction feels like the forehead.

 

30.                     After teaching a woman who has had an evacuation for a hydatidiform mole (molar pregnancy) about her condition, which of the following statements indicates that the nurse's teaching was successful?

A) "I will be sure to avoid getting pregnant for at least 1 year."
B) "My intake of iron will have to be closely monitored for 6 months."
C) "My blood pressure will continue to be increased for about 6 more months."
D) "I won't use my birth control pills for at least a year or two."

 

ANS; A
After evacuation of a hydatiform mole, long-term follow-up is necessary to make sure any remaining trophoblastic tissue does not become malignant. Serial hCG levels are monitored closely for one year and the client is urged to avoid pregnancy for 1 year because it can interfere with the monitoring of hCG levels. Iron intake and blood pressure are not important aspects of follow-up after evacuation of a hydatiform mole. Use of a reliable contraceptive is strongly recommended so that pregnancy is avoided.

 

31.                       Which of the following findings on a prenatal visit at 10 weeks might lead the nurse to suspect a hydatidiform mole?

A) Complaint of frequent mild nausea
B) Blood pressure of 120/84 mm Hg
C) History of bright red spotting 6 weeks ago
D) Fundal height measurement of 18 cm

 

 

ANS; D
Findings with a hydatidiform mole may include uterine size larger than expected. Mild nausea would be a normal finding at 10 weeks' gestation. Blood pressure of 120/84 would not be associated with hydatidiform mole and depending on the woman's baseline blood pressure may be within acceptable parameters for her. Bright red spotting might suggest a spontaneous abortion.

 

32.                     A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. Which finding would the nurse interpret as indicating a therapeutic level of medication?

A) Urinary output of 20 mL per hour
B) Respiratory rate of 10 breaths/minute
C) Deep tendons reflexes 2+
D) Difficulty in arousing

 

ANS; C
With magnesium sulfate, deep tendon reflexes of 2+ would be considered normal and therefore a therapeutic level of the drug. Urinary output of less than 30 mL, a respiratory rate of less than 12 breaths/minute, and a diminished level of consciousness would indicate magnesium toxicity.

 

33.                     Upon entering the room of a client who has had a spontaneous abortion, the nurse observes the client crying. Which of the following responses by the nurse would be most appropriate?

A) "Why are you crying?"
B) "Will a pill help your pain?"
C) "I'm sorry you lost your baby."
D) "A baby still wasn't formed in your uterus."

 

ANS; C
Telling the client that the nurse is sorry for the loss acknowledges the loss to the woman, validates her feelings, and brings the loss into reality. Asking why the client is crying is ineffective at this time. Offering a pill for the pain ignores the client's feelings. Telling the client that the baby wasn't formed is inappropriate and discounts any feelings or beliefs that the client has.

 

34.                     Which of the following data on a client's health history would the nurse identify as contributing to the client's risk for an ectopic pregnancy?

A) Use of oral contraceptives for 5 years
B) Ovarian cyst 2 years ago
C) Recurrent pelvic infections
D) Heavy, irregular menses

 

ANS; C
In the general population, most cases of ectopic pregnancy are the result of tubal scarring secondary to pelvic inflammatory disease. Oral contraceptives, ovarian cysts, and heavy, irregular menses are not considered risk factors for ectopic pregnancy.

 

35.                      In a woman who is suspected of having a ruptured ectopic pregnancy, the nurse would expect to assess for which of the following as a priority?

A) Hemorrhage
B) Jaundice
C) Edema
D) Infection

ANS; A
With a ruptured ectopic pregnancy, the woman is at high risk for hemorrhage. Jaundice, edema, and infection are not associated with a ruptured ectopic pregnancy.

 

36.                     Which of the following findings would the nurse interpret as suggesting a diagnosis of gestational trophoblastic disease?

A) Elevated hCG levels, enlarged abdomen, quickening
B) Vaginal bleeding, absence of FHR, decreased hPL levels
C) Visible fetal skeleton on ultrasound, absence of quickening, enlarged abdomen
D) Gestational hypertension, hyperemesis gravidarum, absence of FHR

ANS; D
Gestational trophoblastic disease may be manifested by early development of preeclampsia (gestational hypertension), severe morning sickness due to high hCG levels, and absence of fetal heart rate or activity. There is no fetus, so quickening and evidence of a fetal skeleton would not be seen. The abdominal enlargement is greater than expected for pregnancy dates, but hCG, not hPL, levels are increased.

 

37.                      It is determined that a client's blood Rh is negative and her partner's is positive. To help prevent Rh isoimmunization, when should the client receive RhoGAM?

A) At 32 weeks' gestation and immediately before discharge
B) 24 before delivery and 24 hours after delivery
C) In the first trimester and within 2 hours of delivery
D) At 28 weeks' gestation and again within 72 hours after delivery

 

ANS; D
To prevent isoimmunization, the woman should receive RhoGAM at 28 weeks and again within 72 hours after delivery.

 

38.                     A woman who is pregnant with twins is at risk for the development of which of the following?

A) Oligohydramnios
B) Preeclampsia
C) Post-term labor
D) Chorioamnionitis

Ans; B
Women with multiple gestations are at high risk for preeclampsia, preterm labor, polyhydramnios, hyperemesis gravidarum, anemia, and antepartal hemorrhage. There is no association between multiple gestations and the development of chorioamnionitis.

39.                     A woman hospitalized with severe preeclampsia is being treated with hydralazine to control blood pressure. Which of the following would the lead the nurse to suspect that the client is having an adverse effect associated with this drug?

A) Gastrointestinal bleeding
B) Blurred vision
C) Tachycardia
D) Sweating

Ans; C
Hydralazine reduces blood pressure but is associated with adverse effects such as palpitation, tachycardia, headache, anorexia, nausea, vomiting, and diarrhea. It does not cause gastrointestinal bleeding, blurred vision, or sweating. Magnesium sulfate may cause sweating.

40.                     After reviewing a client's history, which factor would the nurse identify as placing her at risk for gestational hypertension?

A) Mother had gestational hypertension during pregnancy.
B) Client has a twin sister.
C) Sister-in-law had gestational hypertension.
D) This is the client's second pregnancy

Ans;A
A family history of gestational hypertension, such as a mother or sister, is considered a risk factor for the client. Having a twin sister or having a sister-in-law with gestational hypertension would not increase the client's risk. If the client had a history of preeclampsia in her first pregnancy, then she would be at risk in her second pregnancy.

41.                       A client with hyperemesis gravidarum is admitted to the facility after being cared for at home without success. Which of the following would the nurse expect to include in the client's plan of care?

A) Clear liquid diet
B) Total parenteral nutrition
C) Nothing by mouth
D) Administration of labetalol

Ans; C
Typically, on admission, the woman with hyperemesis has oral food and fluids withheld to rest the gut and receives parenteral fluids to rehydrate and reduce the symptoms. Once the condition stabilizes, oral intake is gradually increased. Total parenteral nutrition may be used if the client's condition does not improve with several days of bed rest, gut rest, IV fluids, and antiemetics. Labetalol is an antihypertensive agent that may be used to treat gestational hypertension, not hyperemesis.

42.                     Which one of the following findings would alert the nurse to the development of HELLP syndrome in a pregnant client?

A) Hyperglycemia
B) Elevated platelet count
C) Disseminated intravascular coagulopathy (DIC)
D) Elevated liver enzymes

D
HELLP is an acronym for hemolysis, elevated liver enzymes, and low platelets. Hyperglycemia is not a part of this syndrome. HELLP may increase the woman's risk for DIC.

43.                     Which of the following would the nurse have readily available for a client who is receiving magnesium sulfate to treat severe preeclampsia?

A) Calcium gluconate
B) Potassium chloride
C) Ferrous sulfate
D) Calcium carbonate

Ans;A
The antidote for magnesium sulfate is calcium gluconate, and this should be readily available in case the woman has signs and symptoms of magnesium toxicity.

44.                     Which assessment finding would lead the nurse to suspect infection as the cause of a client's PROM?

A) Yellow-green fluid
B) Blue color on Nitrazine testing
C) Ferning
D) Foul odor

Ans;D
A foul odor of the amniotic fluid indicates infection. Yellow-green fluid would suggest meconium. A blue color on Nitrazine testing and ferning indicate the presence of amniotic fluid.

45.                      A postpartum patient was in labor for 30 hours and had ruptured membranes for 24 hours. For which of the following would the nurse be alert?

a. Endometritis
b. Endometriosis
c. Salpingitis
d. Pelvic thrombophlebitis

Answer A
Endometritis is an infection of the uterine lining and can occur after prolonged rupture of membranes. Endometriosis does not occur after a strong labor and prolonged rupture of membranes. Salpingitis is a tubal infection and could occur if endometritis is not treated. Pelvic thrombophlebitis involves a clot formation but it is not a complication of prolonged rupture of membranes.

46.                     A primigravida in active labor is about 9 days post-term. The client desires a bilateral pudendal block anesthesia before delivery. After the nurse explains this type of anesthesia to the client, which of the following locations identified by the client as the area of relief would indicate to the nurse that the teaching was effective?

a. Back
b. Abdomen
c. Fundus
d. Perineum

Answer D
A bilateral pudental block is used for vaginal deliveries to relieve pain primarily in the perineum and vagina. Pudental block anesthesia is adequate for episiotomy and its repair.

47.                      A pregnant client is diagnosed with partial placenta previa. In explaining the diagnosis, the nurse tells the client that the usual treatment for partial placenta previa is which of the following?

a. Activity limited to bed rest
b. Platelet infusion
c. Immediate cesarean delivery
d. Labor induction with oxytocin

Answer A
Treatment of partial placenta previa includes bed rest, hydration, and careful monitoring of the client's bleeding.

48.                     Immediately after a delivery, the nurse-midwife assesses the neonate's head for signs of molding. Which factors determine the type of molding?

a. Fetal body flexion or extension
b. Maternal age, body frame, and weight
c. Maternal and paternal ethnic backgrounds
d. Maternal parity and gravidity

Answer A
Fetal attitude—the overall degree of body flexion or extension—determines the type of molding in the head a neonate. Molding is not influence by maternal age, body frame, weight, parity, or gravidity or by maternal and paternal ethnic backgrounds.

49.                     For a patient in active labor, the nurse-midwife plans to use an internal electronic fetal monitoring (EFM) device. What must occur before the internal EFM can be applied?

a. The membranes must rupture
b. The fetus must be at 0 station
c. The cervix must be dilated fully
d. The patient must receive anesthesia

Answer A
Internal EFM can be applied only after the patient's membranes have ruptures, when the fetus is at least at the -1 station, and when the cervix is dilated at least 2 cm. although the patient may receive anesthesia, it is not required before application of an internal EFM device.

50.                     A female adult patient is taking a progestin-only oral contraceptive, or minipill. Progestin use may increase the patient's risk for:

a. Endometriosis
b. Female hypogonadism
c. Premenstrual syndrome
d. Tubal or ectopic pregnancy

Answer D
Women taking the minipill have a higher incidence of tubal and ectopic pregnancies, possibly because progestin slows ovum transport through the fallopian tubes. Endometriosis, female hypogonadism, and premenstrual syndrome are not associated with progestin-only oral contraceptives.