LABOR & DELIVERY/POST PARTUM NURSE COMPETENCY TEST

Transcription

1 DO NOT WRITE ON THE TEST Select the best answer and record your answers on the attached answer sheet. 1. The adult female client has a hemoglobin level of 10.8 g/dl. The nurse interprets that this result is most likely due to which of the following factors in the client s history? a. Chronic obstructive pulmonary disease (CCPD). b. Heart failure. c. Dehydration. d. Iron deficiency anemia. 2. The nurse is preparing to instruct a pregnant client about nutrition. The nurse plans to include which of the following in this client s teaching plan? a. The nutritional status of the mother significantly influences fetal growth and development. b. All mothers are at high risk for nutritional deficiencies. c. Calcium is not important until the third trimester. d. Iron supplements are not necessary unless the mother has iron deficiency anemia. 3. The nurse caring for an Orthodox Jewish client plans a diet that adheres to the practice of Judaism. The nurse plans the diet knowing that which of the following is not a practice of Judaism? a. Eating fish with scales and fins is allowed. b. Meat is allowed if ritually slaughtered. c. Only unleavened bread is eaten during Passover week. d. Meat and milk can be eaten together. 4. The nurse is assigned to assist in caring for a client admitted to the labor unit. The client is 9 cm dilated and is experiencing precipitate labor. A priority nursing action is to: a. Prepare for an oxytocin infusion. b. Keep the client in a side lying position. c. Prepare the client for an epidural anesthesia. d. Encourage the client to start pushing with the contractions. 5. The nurse is assigned to assist in caring for a client with abruptio placentae who is experiencing vaginal bleeding. The nurse collects data from the client knowing that abruptio placentae is accompanied by which of the following additional findings? a. Abdomen soft upon palpation. b. No complaint of abdominal pain. c. Lack of uterine irritability or titanic contractions. d. Uterine tenderness upon palpitation. 6. The nurse caring for a client with abruption placentae is monitoring the client for signs of disseminated intravascular coagulopathy (DIC). The nurse suspects DIC if the nurse observes: a. Pain and swelling of the calf of one leg. b. Rapid clotting times. c. Lab values indicating increased platelets. d. Petechiae, oozing from injection sites, and hematuria.

2 7. A client being prepared for a cesarean delivery is brought to the delivery room. In order to maintain optimal perfusion of oxygenated blood to the fetus, the nurse plans to place the client in a : a. Trendelenburg s position. b. Semi Fowler s position. c. Supine position with a wedge under the right hip. d. Prone position. 8. The nurse is asked to assist the primary health care provider in performing Leopold s maneuvers on a client. Which priority nursing intervention should be implemented before this procedure is performed? a. Locate fetal heart tones. b. Have the client drink 8 oz of water. c. Warm the sonogram gel. d. Have the client empty her bladder. 9. A woman in active labor has contractions every 2 to 3 minutes lasting 45 seconds. The fetal heart rate between contractions is 100 beats/minute. Based on these findings, the priority nursing intervention is to: a. Notify the registered nurse (RN) immediately. b. Encourage relaxation and breathing techniques between contractions. c. Continue monitoring labor and fetal heart rate. d. Monitor maternal vital signs. 10. The nurse reviews the client s health record and notes that based on Leopold s maneuvers, the fetus is a cephalic presentation. The nurse understands that this is: a. An abnormal presentation. b. The least favorable presentation. c. A presentation associated with prolonged labor. d. The most common presentation. 11. The nurse is assigned to care for a client who is in early labor. When collecting data from the client, it is most important for the nurse to first determine which of the following? a. Intensity of contractions. b. Frequency of contractions. c. Baseline fetal heart rate. d. Maternal blood pressure. 12. The nurse is caring for a client in labor. The nurse rechecks the client s blood pressure and determines it has dropped. To decrease the incidence of supine hypotension, the nurse should encourage the client to remain in which position? a. Left lateral. b. Semi Fowler s. c. Squatting. d. Tailor sitting.

3 13. The nurse instructs the client in active relaxation techniques to help her cope with the discomfort of contractions. The nurse determines teaching has been effective when the client tells the nurse that active relaxation includes: a. Assuming a state of mind that is open to suggestions from a coach. b. Believing that a supreme power can help relieve the discomfort of contractions. c. Relaxing uninvolved muscles while the uterus contracts. d. Understanding the origin of contraction discomfort to be more psychological than physical. 14. After a client vaginally delivers a viable newborn, the nurse observes the umbilical cord lengthen and a spurt of blood from the vagina. The nurse recognizes these findings as signs of: a. Abruptio placentae. b. Placenta previa. c. Placental separation. d. Uterine atony. 15. A postpartum client that delivered at 32 weeks gestation would like to breastfeed her preterm infant. At this time, the infant is receiving tube feedings only. What is the nurse s best response to the mother? a. There is no need to prepare for breast feeding now because the infant is receiving tube feedings. b. You can prepare your breast by pinching and rolling the nipples and hand expressing colostrums. c. You can begin pumping as soon as possible after delivery with an electric breast pump. d. You need to pump your breasts every 6 hours to establish a good milk supply. 16. The nurse palpates the fundus and checks the character of the lochia of a postpartum client in the fourth stage of labor. The nurse expects the lochia to be: a. White. b. Pink. c. Serosanguinous. d. Red. 17. Following delivery, the nurse checks the height of the uterine fundus. The nurse expects that the position of the fundus is most likely noted: a. At the level of the umbilicus. b. Above the level of the umbilicus. c. One fingerbreadth above the symphysis pubis. d. To the right of the abdomen. 18. A mother is breast feeding her newborn. The mother complains to the nurse that she is experiencing nipple soreness. The nurse provides which of the following suggestions to the client? a. Avoid rotating breast feeding positions so that the nipple will toughen. b. Stop nursing during the period of nipple soreness to allow the nipples to heal. c. Nurse the newborn infant less frequently and substitute a bottle feeding until the nipples become less sore. d. Position the newborn infant with the ear, shoulder, and hip in straight alignment and with the baby s stomach against the mother s.

4 19. The nurse is assigned to care for a client in the immediate postpartum period who received epidural anesthesia for delivery. The nurse monitors the client for complications. Which of the following best identifies an indicator of a hematoma? a. Complaints of a tearing sensation. b. Complaints of intense pressure. c. Changes in vital signs. d. Signs of heavy bruising. 20. The client received epidural anesthesia during labor and had a forceps delivery after pushing for 2 hours. At 6 hours postpartum, the client s systolic blood pressure (BP) drops 20 points, the diastolic BP drops 10 points, and the pulse is 120 bpm. The client is very anxious and restless. The nurse is told that the client has a vulvar hematoma. Based on this diagnosis, the nurse most appropriately plans to: a. Monitor fundal height. b. Apply perineal pressure. c. Prepare the client for surgery. d. Reassure the client. 21. Following birth, the nurse should plan to prevent hypothermia due to evaporation in the neonate by: a. Warming the crib pad. b. Turning on the overhead radiant warmer. c. Closing the doors to the room. d. Drying the baby with a warm blanket. 22. A 45 year old woman delivered her first baby by cesarean section 5 days ago. The postpartum recovery has been complicated by thrombophlebitis in her left leg. She cries frequently and requests to have her newborn infant stay in the nursery. The nurse recognizes that the mother may have intensified postpartum blues because she is: a. An older first time mother. b. Considering giving the baby up for adoption. c. Required to stay on bed rest. d. Unable to nurse the baby. 23. The postpartum client has lost 700 ml of blood. The vital signs indicate hypovolemia and the uterus remains atonic in spite of treatment. The nurse assisting in caring for the client understands the treatment that is necessary in this situation and prepares the client for: a. A blood transfusion. b. An infusion of oxytocin (Pitocin). c. Emergency surgery. d. Fundal massage. 24. An HIV positive woman delivers a baby. The nurse provides guidance to help the client in decision making regarding newborn care. Which statement is not included in the teaching plan? a. Be sure to wash hands prior to and following bathroom use. b. Launder newborn clothing separately. c. Breast feeding is encouraged, especially for the first 6 weeks postpartum. d. The newborn should be on antiviral drugs for the first 6 weeks after delivery.

5 25. The client asks the nurse why her newborn baby needs an injection of vitamin K. The best response by the nurse is: a. Your baby needs vitamin K to develop immunity. b. The vitamin K will protect your baby from being jaundiced. c. Newborns are deficient in vitamin K. This injection prevents your baby from abnormal bleeding. d. Newborns have sterile bowels. Vitamin K will help the bowel become colonized with the necessary bacteria. 26. The nursing instructor instructs the nursing students that surfactant is a substance needed to facilitate neonatal breathing. The instructor asks a nursing student to identify when this substance is produced. The nursing student responds correctly by stating that this substance is produced at approximately which gestational week: a. Week 12. b. Week 18. c. Week 28. d. Week During the prenatal visit, the nurse checks the fetal heart rate (FHR) using a fetoscope. The nurse determines that the FHR is normal if which of the following heart rates is noted? a. 80 to 100 beats/minute. b. 90 to 120 beats/minute. c. 120 to 160 beats/minute. d. 160 to 180 beats/minute. 28. The nurse is reviewing the record of a pregnant client and notes that the physician has documented the presence of Chadwick s sign. The nurse understands that the hormone responsible for the development of this sign is which of the following? a. Human chorionic gonadotropin (hcg). b. Estrogen. c. Progesterone. d. Prolactin. 29. Butorphanol tartrate (Stadol) is prescribed for the client. The nurse may safely administer this medication to the laboring woman: a. Anytime during labor. b. Up to 15 minutes before anticipated delivery. c. Up to 30 minutes before anticipated delivery. d. Up to 2 to 3 hours before anticipated delivery. 30. A pregnant teenager is receiving magnesium sulfate therapy for the management of preeclampsia. The nurse assisting in caring for the client identifies that the client has developed an unwanted outcome of magnesium toxicity when which of the following is noted? a. Deep tendon reflexes +3/4. b. Serum magnesium level of 6 meq/l. c. Proteinuria of + 3. d. Respirations of 10/minute.

6 LABOR & DELIVERY/POST PARTUM NURSE ANSWER WORKSHEET Name: Date: Total Score: Passing Score: 20/25=80%