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OB PrepU Chapter 21 Exam Questions And Accurate Answers
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OB PrepU Chapter 21 Exam Questions AndAccurate Answers 2024-2025
Tocolytic therapy will prevent preterm birth.
a) False
b) True - Answer a) False
Rationale:
It does not prevent preterm birth, but may delay it.
At 31 weeks' gestation, a 37-year-old woman who has a history of preterm birth
complains of cramps, vaginal pain, and low, dull backache accompanied by vaginal
discharge and bleeding. Her cervix is 2.1 cm long; she has fetal fibronectin in her cervical
secretions, and her cervix is dilated 3 to 4 cm. For what do you prepare her?
a) Careful monitoring of fetal kick counts
b) Bed rest and hydration at home
c) Hospitalization, tocolytic therapy, and IM corticosteroids
d) An emergency cesarean section - Answer c) Hospitalization, tocolytic therapy, and IM
corticosteroids
Rationale:
The gestation age of 31 weeks means every effort should be made to continue the
pregnancy as long as the mother and fetus are tolerating the continuation of the
pregnancy. The rationale for the above is: Stopping the contractions and placing the
patient in the hospital allow for monitoring and a safe place if the woman continues and
delivers. The administration of corticosteroids may help to develop the lungs and prepare
for early preterm delivery. Contraindicated is sending the woman home in the scenario
described. At this time not indicated is an emergency cesarean section. Generally, a
post-term pregnancy will have the woman monitoring fetal kick counts.
A patient is 23 weeks gestation and was admitted for induction and delivery after noting
the infant was an intrauterine fetal death. The patient had fallen 3 days prior to the
diagnosis and landed on her side. What is the most likely attributable cause to the fetal
,death?
a) Genetic abnormality
b) Preeclampsia
c) Placental abruption
d) Premature rupture of membranes
Answer c) Placental abruption
Rationale:
The most common cause of fetal death after trauma is placental abruption when the
placenta separates from the uterus, and it becomes impossible for a fetus to survive.
Genetic abnormalities generally cause spontaneous abortion during the first trimester. It
is also not mentioned in the scenario that there is/was premature rupture of membranes,
neither the possibility of preeclamsia.
A woman is experiencing an amniotic fluid embolism at the time of delivery of the
placenta. Your first action would be to
a) increase her intravenous fluid infusion rate.
b) administer oxygen by mask.
c) apply firm pressure to the fundus of her uterus.
d) instruct the woman to take quick, shallow breaths. -Answer b) administer oxygen by
mask.
Rationale:
An amniotic embolism rapidly progresses to a pulmonary embolism. This is where a
woman might need oxygen to compensate for the sudden blockage of blood through the
lungs.
You are conducting the delivery of the second baby of a healthy young woman. The
pregnancy has been uncomplicated and labor has progressed normally. The delivery of
the fetal head starts but instead of continuing to deliver, the head recoils into the vagina.
What do you try first?
a) Try to push one of the fetus' shoulders in a clockwise or counterclockwise manner.
b) Zavanelli's manoeuvre
c) McRobert's manoeuvre
,d) Fundus pressure. -Answer c) McRobert's maneuver
Rationale:
This is an intervention used with a large baby who may have shoulder dystocia and need
some help. The legs are sharply flexed, by a support person or nurse, and the movement
will help to open the pelvis to the widest diameter possible. With a Zavanelli maneuver,
the practitioner pushes the fetal head back in the birth canal and then performs an
emergency cesarean delivery. Fundal pressure is contraindicated with shoulder dystocia.
It is out of the province of the LVN to attempt delivery of the fetus by pushing one of the
fetus' shoulders in a clockwise or counterclockive motion.
A client in week 38 of her pregnancy has an ultrasound performed at a routine office visit
and learns that her fetus has not moved out of a breech position. What intervention does
the nurse expect for this client?
a) Forceps birth
b) Trial labor
c) External cephalic version
d) Vacuum extraction Answer c) External cephalic version
Rationale:
External cephalic version External cephalic version is a procedure in which a fetus that is
presenting in other than a cephalic position is moved to a cephalic position before birth.
The procedure can be performed as early as 34 to 35 weeks, although generally it is
reserved for about 37 to 38 weeks of pregnancy. A trial birth is done when the inlet
measurement of the woman is borderline, or just adequate; the lie and position of the
fetus are good; and the labor is allowed to take its normal course as long as the descent
of the presenting part and dilatation of the cervix continue. These include forceps, which
are rarely used today, and vacuum extraction to assist in deliveries when other
complicating factors exist but would be less apt to utilize with a fetus in breech
presentation.
A nurse is caring for a client who has just begun labor and who has delivered vaginally
five times previously. Which of the following interventions will the nurse most likely need
to perform to meet the needs of this particular client?
a) Prepare the client for cesarean birth
b) Prepare to administer oxytocin
c) Darken the room lights
, d) Convert the birthing room to birth readiness before full dilatation is obtained
Answer d) Convert the birthing room to birth readiness before full dilatation is obtained
Rationale:
Both grand multiparas (women who have given birth five or more times) and women with
histories of precipitate labor should have the birthing room converted to birth readiness
before full dilatation is obtained. Then, in case of a precipitous birth, the patient delivers
in a controlled environment. Since the client is expected to deliver relatively quickly,
there is no need for oxytocin or dimming the room lights. Nor is there an indication for
cesarean birth, especially since all of the client's births were delivered vaginally.
A nurse is evaluating a full-term client in labor and finds the fetus to be in an occiput
posterior position. The client reports all her discomfort is located in her lower back. What
nursing intervention can be performed to help alleviate this discomfort?
a) Have the physician administer a pudendal block.
b) Position the client supine with the head of bed elevated 30 degrees.
c) Apply a warm washcloth to the lower back.
d) Apply counter pressure to the lower back with a fist. -Answer d) Apply counter
pressure to the lower back with a fist.
Rationale:
Counter pressure applied to the lower back with a fisted hand sometimes helps the
woman to cope with the "back labor" characteristic of the occiput posterior position.
You identify that a woman's fetus is in an occiput posterior position. Which of the
following best identifies how you would expect her labour to differ from others?
a) Requires manual rotation of the baby.
b) Increased back pain.
c) Shorter dilatational stage of labor.
d) Requires vacuum extraction to deliver. -Answer b) Increased back pain.
Rationale:
Many women whose fetus is in a posterior position have back pain while in labor.
Pressure against the back by a support person often reduces this type of pain. An
occiput posterior position does not make for a shorter dilatational stage of labor, it does
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