Labor and Delivery

The nurse is caring for a 34-year-old G1P0 patient in her 30th week of gestation. The patient is having an episode of painless vaginal bleeding and is hemodynamically stable. Which assessment does the nurse anticipate for the physician to order?

A 26-year-old woman at 8 weeks of pregnancy presents for a consultation. Her last menstrual period was September 9, 2018. Which of the following is the expected date of delivery by Naegele's rule?

The patient in the clinic requests information on preventing pregnancy and sexually transmitted infections. The nurse advises the patient about which strategy?

Which finding in a client receiving a continuous magnesium sulfate infusion for preeclampsia indicates toxicity?

The nurse has been called to help with a 24-year-old G1P0 female with a viable intrauterine pregnancy at 42-weeks’ estimated gestational age. Patient is not in active labor, following an arrest of descent at the end of the first stage of labor. There was meconium detected in the amniotic fluid after PROM, and the fetus has had multiple episodes of bradycardia and late decelerations. Patient has a history of cocaine abuse. Which of the following statements is most correct regarding the management of this neonate when it is delivered?

The labor and delivery nurse is assigned to a 25-year-old G2P1 female with a viable intrauterine pregnancy at 40-weeks estimated gestational age. After the patient had PROM, dark green fluid was noted, which was not malodorous. Which of the following terms does the nurse use to document this finding?

Which of the following may benefit from inhaled surfactant therapy? Select all that apply.

The nurse is called to assist a 32-year-old G1P0 female who is in active labor with a viable intrauterine pregnancy at 30-weeks estimated gestational age. The patient delivers a neonate who requires intubation due to secondary apnea. The nurse auscultates to assess for endotracheal tube placement and notes breath sounds are louder on the right than the left. Which of the following is the next best step in management?

The nurse is called to assist a 29-year-old G1P0 female with a viable intrauterine pregnancy at 42-weeks estimated gestational age who is in active labor. During spontaneous vaginal delivery of the neonate, shoulder dystocia occurs. The nurse should carefully assess the neonate for which of the following common complication of shoulder dystocia?

The neonate experiences respiratory distress immediately after birth and is intubated after receiving bag-mask ventilation. The nurse notes copious oral secretions and is unable to pass a nasogastric tube or an orogastric tube. Upon assessment, the nurse notes the child has small eyes, malformed ears, and a micropenis. Which of the following genetic disorders does this neonate most likely have?

The nurse is called to assist with a 25-year-old G1P0 female with a viable intrauterine pregnancy at 40-weeks gestational age. Patient is already in the second stage of labor and quickly delivers a vigorous, healthy infant without complications. The neonate is placed skin-to-skin with mom and latches well to breastfeed but becomes acutely cyanotic after two minutes of eating. Once separated from the breast, the baby begins to cry, and the cyanosis resolves. Which of the following interventions by the nurse is most appropriate?

The nurse is caring for a pregnant 25-year-old female who is late in her second trimester. When coming in for a checkup, she has a blood pressure of 170/120 mm Hg and has a 2+ protein in her urine. Which is the most likely complication of this patient’s diagnosis?

A fetus is diagnosed in utero with autosomal recessive polycystic kidney disease. The mother is noted to have severe oligohydramnios. Which statement is most accurate for the prognosis of the fetus?

The nurse is attending the delivery of a full-term neonate whose mother received poor prenatal care. The neonate has cyanosis, increased work of breathing, a barrel chest, and a scaphoid abdomen. The nurse auscultates the patient’s lung fields and notes bowel sounds over the left side of the chest. The nurse suspects which condition in this neonate?

A pregnant patient with pre-eclampsia is receiving a magnesium sulfate infusion. Which early symptom, if present in the patient, indicates the patient’s magnesium level is becoming toxic?

The nurse notes a mother attempting to remove the vernix from her newborn baby during a bath. Which response by the nurse is most appropriate?

The nurse is counseling the pregnant woman on care the baby will receive after birth. Which statement by the nurse is correct?

Which type of heat loss has the greatest effect on a neonate immediately after delivery?

The 4-hours-old neonate is brought to the special care nursery from the mother’s room for an assessment. The temperature is 35.4° Celsius. Which initial action does the nurse take?

The nurse is providing discharge teaching to a new mother. Which of the following statements about the neonate’s sleep patterns is correct?

Which patients may benefit from exogenous surfactant administration? Select all that apply.

The 24-year-old G1P0 female at 32 weeks estimated gestational age presents to the labor and delivery unit with recent onset of contractions and rupture of membranes. Which finding, if present in this patient, most definitively indicates the patient has entered the second stage of labor?

The nurse is caring for a G3P0 female at 40 weeks estimated gestational age in the second stage of labor. The patient does not have an epidural in place. After how many hours does the nurse contact the provider to report a prolonged second stage of labor?

Place the cardinal movements the fetus makes during labor in the correct order from start to finish.

A 31-year-old G2P1 female at 37 weeks estimated gestational age presents reporting contractions. Which question by the nurse would best determine if the patient is in labor?

The 25-year-old G1P0 female at 31 weeks estimated gestational age presents to the labor and delivery unit. The nurse assesses the patient and palpates the head of the fetus to be 2 inches above the maternal ischial spines. Which term does the nurse use to document this finding?

The woman who is 32-weeks-pregnant presents to a prenatal appointment reporting irregular contractions that occur a few times per day. Upon assessment, the patient's cervix is noted to be closed, long, and high. Which action by the nurse is most appropriate? 

Which statement by the patient with placenta accreta indicates they understand the nurse’s teaching?

The premature neonate with severe intrauterine growth restriction is being evaluated for possible in utero TORCH organism exposure. The nurse obtains lab specimens to test for which organisms? Select all that apply.

The pregnant patient has experienced preterm premature rupture of membranes (PPROM) at 32 weeks. The patient is not in active labor. The nurse is aware this patient is most at risk for which complication?

An infant of 32 weeks gestation is born precipitously and is noted to be pale and limp. Resuscitative actions are initiated. At one minute of life, the infant has a pinkish central body, bluish hands and feet, a heart rate of 135 bpm, grimaces with painful stimuli, remains limp, and exhibits gasping respiration. Assign an Apgar score to this neonate using a whole number.

The nurse in the neonatal intensive care unit receives report from the Labor and Delivery nurse about a full-term neonate and learns the patient’s Apgar scores were 0-0-1-5 at 1, 5, 10, and 15 minutes of life, respectively. How does the nurse interpret this information?

The full-term neonate is born via normal spontaneous vaginal delivery (NSVD). The neonate cries at the perineum and maintained flexion against gravity but is noted to be bluish gray. Which intervention is appropriate?

The neonate of 36 weeks estimated gestational age is born via emergency cesarean section, appears limp, blue, and apneic, and is brought to the warming table. He is warmed, dried, and stimulated, and a pulse oximeter is placed on his right wrist. At 30 seconds of life, his heart rate is 66 bpm and his oxygen saturation is 54%. Positive pressure ventilation is initiated via CPAP bag and mask. At one minute of life, the heart rate is 118 bpm, the extremities are still blue but the trunk is pink, and he begins to move and cry with stimulation. The nurse documents which number for the Apgar score? Enter your answer using a whole number.

The neonate born at 41 weeks gestation is diagnosed with persistent pulmonary hypertension of the newborn (PPHN). Which information does the nurse give the mother about this condition?

The nursing student is reviewing the pregnant patient’s chart and notes the patient is gravida 4 para 2. Which interpretation of the patient’s obstetric history by the nursing student most likely requires correction by the nurse?

A newborn was delivered one minute ago. He is not breathing, has a heart rate of 128 bpm, has a moderate amount of lanugo, has some muscle tone without active movement, does not grimace with stimuli, and has a pink body with blue extremities. Which APGAR score is correct?

A cesarean section is the only safe method of delivery for the fetus when the pregnant woman has which condition? 

The G2P1 patient who is 33 weeks pregnant is brought via ambulance to the emergency department due to significant vaginal bleeding and abdominal pain. Which action does the nurse take first?

The 38-year-old gravida 1 para 1 patient presents to the clinic in the 8th week of gestation.The patient’s fasting blood sugar test result is 130 mg/dL. The nurse anticipates which diagnosis? 

Maternal infection with which organism(s) during pregnancy may lead to neonatal seizures? Select all that apply.

A new mother is discussing alcohol consumption while breastfeeding her baby. Which statement indicates a need for further teaching? 

The 17-year-old pregnant female patient presents for her first prenatal visit. The nurse plans care based on which understanding of recommended screening?

The nurse receives report on a 24-year-old G1P0 female at 32 weeks estimated gestational age who presents with pre-eclampsia with severe features. The nurse expects the patient to exhibit which symptom? 

The nurse knows which immunoglobulins are passed to the neonate through breastfeeding? Select all that apply.

A 23-year-old pregnant woman presents to the clinic stating, “I am a teacher and have heard there is a measles outbreak in my community. I want to get the measles vaccine to protect my baby and myself. Which response by the nurse is most appropriate?

The 39-week-gestation neonate is born to a mother with chorioamnionitis. The provider has ordered ampicillin 75 mg/kg/day in divided doses every 8 hours and administered intravenously. The neonate weighs 4.2 kg. How many milligrams does the nurse administer with each dose? Enter your answer using a whole number.

The 25-week-gestation neonate is ordered to receive ampicillin 100 mg/kg/day intravenously divided into doses every 12 hours immediately after birth. The neonate weighs 745 grams. The pharmacy dispenses ampicillin in a 5 mL vial that contains 125 mg. How many milliliters will the nurse administer with each dose? Round your answer to the nearest tenth decimal.

A nurse is discussing abortion with a distraught pregnant woman. The nurse understands that the patient is most likely struggling with which pair of ethical principles?

Which patient is the nurse’s first priority?