1 .		To increase the pelvic outlet of a woman in labor, the nurse should instruct her to    lie on either her right or left side.   position herself on her hands and knees.   sit on her buttocks.   practice Kegel exercises.
2 .		An expectant couple asks the nurse to help them understand the different types of childbirth education. When discussing Lamaze, the nurse should include that the primary purpose of Lamaze is to    help the woman to avoid medication during labor and delivery that could harm the fetus.   provide education and strategies to help the woman through labor and delivery.   give the mother and her coach something to focus on apart from the pain of labor and delivery.   enhance the emotional relationship between the mother and her coach so that she can keep herself focused during labor and delivery.
3 .		The term for light stroking of the abdomen to distract an actively laboring client from the pain of contractions is called    psychoprophylaxis.   Kegel exercises.   effleurage.   neuromuscular disassociation.
4 .		Vaginal examination of a laboring primigravida woman finds the presenting part 1 cm above the ischial spines. Based on this finding, the nurse should document that the presenting part is    -1 station.   +1 station.   floating.   engaged.
5 .		A pregnant woman at term is admitted to the birthing center with strong contractions every 2-3 minutes and lasting 60-90 seconds. Vaginal examination reveals a completely effaced and dilated cervix and the presenting part at station 0. The nurse should interpret the findings as consistent with the    first stage of labor.   second stage of labor.   third stage of labor.   transition stage of labor.
6 .		At 38 weeks' gestation, a primigravida woman comes to the birthing center. She states she has been having strong contractions every 5-6 minutes during the past 2 hours. Which question asked by the nurse should elicit the most relevant assessment data?    "Have you lost any weight this week?"   "Is the discomfort primarily in your abdomen?"   "Do the contractions bother you more when you're up?"   "Have you had a sudden burst of energy in the past two days?"
7 .		Vaginal examination of a multipara in active labor finds the fetal head at +2 station, the sagittal suture in the midline, and a triangular-shaped fontanelle superior. The nurse should record the fetal position as occiput-    anterior.   oblique.   posterior.   transverse.
8 .		Leopold's maneuvers find a hard, rounded mass in the fundus and a smooth, resistant curve on the maternal right side. In which maternal quadrant should the nurse anticipate locating the fetal heart tones?    left upper   left lower   right upper   right lower
9 .		A pregnant woman who had her first child one year ago arrives at the birthing center in active labor. Vaginal examination finds a cephalic presentation in occiput-posterior position. The nurse should anticipate that the laboring woman will most probably experience    rapid labor progress.   cesarean delivery.   severe back pain.   longer, stronger contractions.
10 .		While reviewing the prenatal record of a primapara woman who was admitted to the labor and delivery unit in active labor, the nurse notes the notation "marginal android pelvis." This notation should indicate to the nurse that there may be a potential problem during labor at the point when the fetus goes through    internal rotation.   extension.   external rotation.   restitution.
11 .		A woman was admitted four hours ago to the birthing center for inactive labor. The nurse compares a client's admission baseline blood pressure with one taken just before the last contraction and notes a change from 124/82 to 158/106. The woman's blood pressure between contractions is 126/82. The nurse should interpret the sudden elevation as indicative of    a physiological response to the psychological experience of labor.   a normal hemodynamic response to labor.   compromised utero-placental functioning.   pregnancy-induced hypertension.
12 .		While performing Leopold's maneuvers on a pregnant woman, the nurse palpates a hard, rounded mass on the maternal left side and a softer mass on the right. Fetal heart tones are ausculated clearly just below the umbilical midline. Based on these findings, the nurse should anticipate that the vaginal examination will find    a diamond-shaped fontanelle superior.   a triangular-shaped fontanelle superior.   the right-acromion-dorsal-anterior.   the left-sacrum-anterior.
13 .		A pregnant woman comes to the birthing center for the second time in 2 days complaining of severe back pain with contractions. She states she has "been in labor for 3 days," and that her contractions are coming very 4-8 minutes. A pelvic examination reveals that the woman is 2 cm dilated, 50 percent effaced, and at a -2 station. Based on these findings, the nurse shares with the woman that she is in the    latent phase of labor.   active phase of labor   second stage of labor.   third stage of labor.
14 .		The labor and delivery nurse is caring for an actively laboring woman who is 3 cm dilated, very agitated, and screaming at her partner, "I can't do this! I just can't do this! I know I can't do this! I want a cesarean now!" The nurse's priority should be to    obtain an epidural anesthetic for the woman.   provide the woman information regarding her options for pain relief.   obtain an order for a medication that will help to calm the woman.   establish firm eye contact and help the woman focus on gaining control over the moment.
15 .		A pregnant woman at term calls the birthing center stating that she has diarrhea, a disorienting feeling of "more space inside," a dull backache, but no contractions. Based on this information, the nurse suspects that the    fetus is turning to a breech position.   fetus is in an occiput-posterior position.   woman needs to be evaluated for beta-strep.   woman will be starting to have contractions within the day.
16 .		When caring for a laboring pregnant woman with a large fetus, the nurse should prepare for the potential of shoulder dystocia occuring during    external rotation   internal rotation   restitution   expulsion
17 .		A woman with a term pregnancy is admitted to labor and delivery, 1 cm dilated, with mild to moderate contractions every 5-7 minutes which last 30-35 seconds. The nurse, who is serving as her labor coach, notes all of the following behaviors. Which behavior suggests that the woman needs assistance in performing Lamaze techniques?    The woman alternately dorsiflexes and relaxes feet as each contraction begins.   The woman strokes her abdomen in a circular motion throughout the contraction.   The woman is breathing from her chest at a rate of 8-10 breaths/contraction.   The woman maintains a semi-Fowler's position throughout the contraction interval.
18 .		While caring for a laboring woman with an external fetal monitor, the nurse notes that over a 15-minute period the monitor records repeated uniform decelerations that begin just before the contraction and reach their lowest point at acme. Based on this finding, the nurse's priority should be to    elevate the woman's hips on two pillows.   position the woman in left Sims' position.   notify the primary health care provider of the findings.   reassure the woman that the pattern is normal.
19 .		The nurse is evaluating the fetal response to moderate uterine contractions that occur every 3 minutes and last 60-70 seconds. Assessment findings include fetal heart rate of 137 bpm, long- and short-term variability, early decelerations, and two accelerations of 20 bpm lasting 20 seconds that occur within a 10 minute period. The best interpretation by the nurse is that these findings are    reassuring.   non-reassuring.   sinusoidal.   fetal sleep.
20 .		When caring for a primipara woman who is 6 cm dilated and receiving continuous epidural analgesia, the nurse should be particularly alert for the most common side effect of    maternal respiratory depression.   maternal hypotension.   fetal bradycardia.   fetal stimulation.
21 .		A woman with a term pregnancy who is in active labor is admitted to labor and delivery. She is 2 cm dilated, exhibiting difficulty in dealing with the contractions, and requesting epidural anesthesia. Her vital signs are within normal limits. The nurse's response should be based on the information that in early labor epidural anesthesia should only be used    following a fetal biophysical profile since it can cause neonatal respiratory depression.   during early labor for women who are hypertensive since it lowers maternal blood pressure.   after the woman has dilated at least 4 cm, since it prolongs labor.   if a woman wants to take a non-active role in the childbirth experience.
22 .		When caring for a woman with a term pregnancy who is in active labor and has received regional analgesia, once blood pressure has been assessed, the nurse should particularly focus on the signs of    amniotic fluid embolus.   bladder distention.   uterine hypotonia.   nausea.
23 .		A woman has a vaginal birth with epidural anesthesia of a boy who is at 39 weeks' gestation in a labor and delivery unit. Two hours after the delivery, the woman complains of severe generalized itching. The nurse's immediate response should be to    encourage the woman to void.   initiate hospital protocol for anaphylactic shock.   administer an antihistamine as per CNM/MD order.   administer naloxone per protocol to abort impending respiratory depression.
24 .		A woman with a term pregnancy whose labor is being induced has just received an intrauterine pressure catheter (IUPC) from her primary health care. The woman asks the nurse the reason for the catheter. The nurse's response should be based on the understanding that the IUPC is used when    persistent variable decelerations with good return to baseline are present.   there is a need for particularly accurate monitoring of labor contractions.   uterine contractions indicate that there will be an abbreviated second stage of labor.   there is a high risk of uterine rupture.
25 .		While admitting a woman with a term pregnancy to labor and delivery, the nurse notes that the umbilical cord has prolapsed outside of the vagina. The nurse should immediately    evaluate the umbilical cord for knots.   place the umbilical cord back into the uterus.   instruct the woman to move into a knee-chest position.   turn the woman on her left side with her hips elevated 30 degrees.
26 .		When caring for a laboring pregnant woman who has just received an initial dose of continuous epidural anesthesia, the nurse's priority should be to assess    blood pressure.   urinary bladder status.   placement of the epidural catheter.   the degree of numbness experienced by the woman.
27 .		During the initial labor and delivery admission assessment of a multipara woman in active labor, the woman's membranes spontaneously rupture. On inspection, the nurse notes that the fetal head is visible at the vaginal introitus. Which of these actions, if taken by the nurse, would result in potential serious injury to the woman and her fetus? The nurse    supports the perineum and fetal head during expulsion.   applies downward traction on the head to deliver the anterior shoulder.   exerts downward traction on the umbilical cord to deliver the placenta.   places the newborn in head-dependent position on the mother's abdomen.
28 .		The initial admission assessment of a multipara woman to the birthing center reveals a cervix 2 cm dilated and 50 percent effaced, ruptured membranes, mild contractions 5-7 minutes apart, fetal heart tones of 145 beats per minute, and fetus in a vertex position with a ballottable presenting part. Based on these findings, the nurse should anticipate the need to    prepare the woman for an ultrasonography.   encourage the woman to alternate side-lying and knee-chest positions.   assist the woman with ambulation to assist fetal descent.   explain procedures associated with cesarean delivery to the woman.
29 .		During the admission assessment of a woman with a term pregnancy who is in active labor, Leopold's maneuvers reveals a large, round, hard fundal mass; a smooth resistant curve on the maternal right; and small parts near the midline. Fetal heart tones of 148 beats per minute are located in the right upper quadrant. Based on these findings, the nurse should be particularly alert for signs of    umbilical cord knot.   umbilical cord prolapse.   port wine-colored amniotic fluid.   meconium-stained amniotic fluid.
30 .		A woman with a term pregnancy is admitted to the hospital emergency department accompanied by her partner. Assessment reveals that she is in the second stage of labor, fetal heart tones are 132 beats per minute, and that the fetal is presenting with a posterior mentum. During the process of preparing the woman for a cesarean delivery, the nurse should    discuss and demonstrate postoperative behaviors, such as abdominal splinting, coughing, and deep breathing.   provide time for the client and her partner to verbalize their anxieties and concerns.   describe the potential effects of face presentation on the newborn's appearance.   explain common psychological and physical postpartum events.
31 .		The nurse is caring for a woman in postpartum who had a forceps-assisted vaginal delivery of a term boy one hour earlier. The woman begins to complain of feeling dizzy and appears pale and tachypneic. The woman's fundus is firm and she appears to be having heavy lochia rubra. Based on the nurse's knowledge of the woman's birth and the assessment findings, the nurse should suspect that the woman is experiencing    hypovolemic shock secondary to uterine atony.   postpartal hemorrhage secondary to vaginal laceration.   stress-induced vaginal hematoma.   disseminated intravascular coagulopathy (DIC).
32 .		When caring for a woman who has just delivered a stillborn boy who is at 39 weeks' gestation, the nurse should take all of the following actions EXCEPT    encourage the woman to express her grief over the boy's death.   explain common causes of fetal death to the woman.   immediately remove the boy from the room.   express empathy to the woman for her loss.
33 .		At change of shift a nurse is assigned to care for a woman whose labor is being induced with oxytocin (Pitocin) on the labor and delivery unit. The nurse's assessment reveals all of the following findings. Which finding indicates that the Pitocin should be discontinued?    nausea and vomiting   apical pulse 20 beats per minute below baseline pulse   moderate to strong contractions lasting 70 seconds q 2 minutes   fetal heart tones of 157 beats per minute
34 .		The admission assessment of a multipara woman with a term pregnancy reveals that her cervix is 3 cm dilated and 30 percent effaced, her membranes are ruptured, and the fetal presenting part is at -2 station. Based on these findings, the nurse's priority should be to instruct the woman to    lie on her side to facilitate fetal movement.   anticipate the need for a cesarean delivery due to cephalopelvic disproportion.   remain in bed to prevent cord prolapse.   perform effleurage to facilitate relaxation of the uterus.
35 .		A woman who is 38 weeks' gestation is admitted to labor and delivery with painless, bright red vaginal bleeding. The woman's vital signs are stable, the fetal heart tones are 125 beats per minute in the lower left quadrant, and contractions are moderate and 4 minutes apart. Based on these findings, the nurse should suspect that the woman has placenta    previa.   accreta.   abruptio.   battledore.
36 .		When preparing a teaching plan on episiotomies, the nurse should include that an episiotomy may    greatly increase the risk of postpartal infection.   increase stress on the fetal presenting part.   decrease trauma to the perineum.   decrease the length of the third stage of labor.
37 .		While caring for a woman with a term pregnancy undergoing a vacuum extraction, the nurse's priority should be to    support the woman's pubococcygeal muscle during the procedure.   assess the fetal heart rate throughout the procedure.   assess the woman's blood pressure.   determine the time of birth.
38 .		When caring for a woman with a term pregnancy, the nurse should determine the fetal attitude by    assessing fetal heart tones.   identifying the fetal presenting part.   performing Leopold's maneuvers on the fetus.   asking the woman to identify fetal movements.
39 .		A woman with a term pregnancy tells the nurse, "I can finally breathe again, but my bladder seems to be constantly full." Based on this statement, the nurse should explain to the woman about    lightening.   ballottement.   effleurage.   false labor.
40 .		A woman who is 38 weeks' pregnant and in active labor has asked the nurse to help her implement nonpharmacological pain relief strategies. Using the gate-control theory of pain as a guide, the best response by the nurse should be to teach the woman the use of    effleurage.   pelvic rocking.   Kegel exercises.   counter-pressure.
41 .		While supporting a pregnant woman in labor, the nurse notes that the woman's blood pressure is 125/70, her pulse rate is 82 beats per minute, respiratory rate is 90 breaths per minute, and the woman is complaining of tingling in her fingers and toes, and dizziness. Based on these data, the nurse should suspect that the woman is    inhaling too little oxygen.   going into circulatory overload.   exhaling too much carbon dioxide.   experiencing decreased cardiac output.
42 .		The nurse is caring for a woman who is 38 weeks' pregnant and in active labor when the woman's amniotic membranes rupture at the height of a contraction. The nurse's priority should be to    assess the color, amount, and odor of the amniotic fluid.   document the time of the membranes' rupturing.   identify cervical dilatation and effacement.   assess the fetal heart tones.
43 .		A woman who is at 40 weeks' gestation is admitted to labor and delivery with mild to moderate uterine contractions every 7-10 minutes, and a long, closed cervix. Based on the admission assessment, the nurse should anticipate that the woman will    be encouraged to perform pelvic rocking exercises.   be prescribed a dose of secobarbital (Seconal) to promote relaxation and sleep.   have her labor augmented by the application of prostaglandin gel to her cervix.   have a pudendal block administered to promote cervical dilatation and effacement.
44 .		A woman with a history of cocaine use visits the prenatal clinic for the first time when she is 28 weeks' pregnant. Based on the woman's history, the nurse should provide anticipatory guidance to the woman regarding the signs and symptoms of    placenta abruptio.   pelvic inflammatory disease.   cephalopelvic disproportion.   umbilical cord compression.
45 .		A woman who is 30 weeks' pregnant comes to the antepartal clinic for her initial visit. During the nursing assessment, the uterine fundus is palpated at 27 centimeters above the symphysis pubis, the fetus is easily palpated and is not ballottable. Based on these assessment findings, the nurse should suspect that the woman has    oligiohydramnios.   a microcephalic fetus.   a fetus in breech presentation.   meconium-stained amniotic fluid.
46 .		A woman is admitted at 41 weeks' gestation for an induction of labor. The plan is to ripen her cervix by application of prostaglandin gel, to be followed by oxytocin. When caring for this woman, the nurse should be aware that the gel will be removed if the woman begins to experience    uterine atonicity.   uterine hyperstimulation.   uterine prolapse.   uterine anteversion.
47 .		The nurse is setting up an oxytocin (Pitocin) induction of labor for a woman who is at 42 weeks' gestation as per institutional guidelines and physician orders. Which of the following steps, if taken by the nurse, could result in injury to the woman and her fetus? The nurse    adds 10 units of Pitocin to 1L of 5 percent dextrose in lactated Ringer's solution.   notes the addition of the Pitocin to the 5 percent dextrose in lactated Ringer's solution and on the fluid bag.   threads the tubing through an intravenous pump.   attaches intravenous tubing directly to the fluid bag and inserts the other end of the tubing into the intravenous catheter.
48 .		A woman with a term pregnancy is admitted to the labor and delivery unit for a scheduled cesarean birth due to a persistent transverse fetal lie. The woman shares with the nurse that she feels depressed because she no longer has any control over her childbearing experience. The nurse's best response should be based on the understanding she    can participate in some decision-making surrounding the delivery experience.   can participate in decision-making regarding infant and postpartal care.   needs to trust that her health care providers have considered the best interests of her infant as well as herself.   needs to focus all of her energy on undergoing and recovering from major abdominal surgery so that she can actively participate in her infant's care.
49 .		The nurse's assessment for a 1 minute Apgar score of a newborn girl reveals the following findings: the newborn grimaces but does not cry without stimulation; skin color is pink; hands and feet are blue; irregular respirations equal 24 breaths per minute; apical pulse equals 110 beats per minute; extremities are slightly flexed. Based on these findings, the nurse should record the 1-minute Apgar score as    5.   6.   7.   9.