Maternity Nursing 8e Lowdermilk Perry Cashion Test bank

Maternity Nursing  8e Lowdermilk Perry Cashion  Test bank
Product Code: 222
Availability: In Stock
Price: $24.99
Qty:     - OR -   Add to Wish List
Add to Compare

Description

Lowdermilk: Maternity Nursing, 8th Edition

Chapter 11: Fetal Assessment during Labor

Test Bank

MULTIPLE CHOICE

1. The nurse providing care for the laboring woman should understand that variable fetal heart rate (FHR) decelerations are caused by:
a.
Altered fetal cerebral blood flow.
b.
Umbilical cord compression.
c.
Uteroplacental insufficiency.
d.
Fetal hypoxemia.

ANS: B

Feedback
A
Altered fetal cerebral blood flow would result in early decelerations in the FHR.
B
Variable decelerations can occur any time during the uterine contracting phase and are caused by compression of the umbilical cord.
C
Uteroplacental insufficiency would result in late decelerations in the FHR.
D
Fetal hypoxemia would result in tachycardia initially and then bradycardia if hypoxia continues.

DIF: Cognitive Level: Knowledge REF: 326
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

2. While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate (FHR) for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. The nurses first priority is to:
a.
Change the womans position.
b.
Notify the care provider.
c.
Assist with amnioinfusion.
d.
Insert a scalp electrode.

ANS: A

Feedback
A
Late decelerations may be caused by maternal supine hypotension syndrome. They usually are corrected when the woman turns on her side to displace the weight of the gravid uterus from the vena cava.
B
If the fetus does not respond to primary nursing interventions for late decelerations, the nurse would continue with subsequent intrauterine resuscitation measures, including notifying the care provider.
C
An amnioinfusion may be used to relieve pressure on an umbilical cord that has not prolapsed. The FHR pattern associated with this situation most likely reveals variable deceleration.
D
A fetal scalp electrode would provide accurate data for evaluating the well-being of the fetus; however, this is not a nursing intervention that would alleviate late decelerations, nor is it the nurses first priority.

DIF: Cognitive Level: Application REF: 326
OBJ: Client Needs: Physiologic Integrity
TOP: Nursing Process: Implementation

3. The nurse caring for the laboring woman should understand that early decelerations are caused by:
a.
Altered fetal cerebral blood flow.
b.
Umbilical cord compression.
c.
Uteroplacental insufficiency.
d.
Spontaneous rupture of membranes.

ANS: A

Feedback
A
Early decelerations are the fetuss response to fetal head compression.
B
Variable decelerations are associated with umbilical cord compression.
C
Late decelerations are associated with uteroplacental insufficiency.
D
Spontaneous rupture of membranes has no bearing on the fetal heart rate unless the umbilical cord prolapses, which would result in variable or prolonged bradycardia.

DIF: Cognitive Level: Comprehension REF: 325
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

4. What three measures should the nurse implement to provide intrauterine resuscitation? Select the response that best indicates the priority of actions that should be taken.
a.
Call the provider, reposition the mother, and perform a vaginal examination.
b.
Administer oxygen by face mask, assist the woman to a side-lying position, and increase maternal blood volume by increasing the rate of the primary IV.
c.
Administer oxygen to the mother, increase IV fluid, and notify the care provider.
d.
Perform a vaginal examination, reposition the mother, and provide oxygen via face mask.

ANS: B

Feedback
A
The nurse should initiate intrauterine resuscitation in an ABC manner, similar to basic life support. The first priority is to optimize oxygenation of the circulatory volume by providing oxygen via face mask. The second action is to open the maternal and fetal vascular systems by repositioning the mother for improved perfusion. The third step is to increase blood volume by increasing the IV fluid. If these interventions do not resolve the fetal heart rate issue quickly, the primary provider should be notified immediately.
B
These are the correct nursing actions for intrauterine resuscitation.
C
The nurse should initiate intrauterine resuscitation in an ABC manner, similar to basic life support. The first priority is to optimize oxygenation of the circulatory volume by providing oxygen via face mask. The second action is to open the maternal and fetal vascular systems by repositioning the mother for improved perfusion. The third step is to increase blood volume by increasing the IV fluid. If these interventions do not resolve the fetal heart rate issue quickly, the primary provider should be notified immediately.
D
The nurse should initiate intrauterine resuscitation in an ABC manner, similar to basic life support. The first priority is to optimize oxygenation of the circulatory volume by providing oxygen via face mask. The second action is to open the maternal and fetal vascular systems by repositioning the mother for improved perfusion. The third step is to increase blood volume by increasing the IV fluid. If these interventions do not resolve the fetal heart rate issue quickly, the primary provider should be notified immediately.

DIF: Cognitive Level: Evaluation REF: 330
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Implementation

5. The nurse caring for the woman in labor should understand that maternal hypotension can result in:
a.
Early decelerations.
b.
Fetal dysrhythmias.
c.
Uteroplacental insufficiency.
d.
Spontaneous rupture of membranes.

ANS: C

Feedback
A
Maternal hypotension is not associated with early decelerations.
B
Maternal hypotension is not associated with fetal dysrhythmias.
C
Low maternal blood pressure reduces placental blood flow during uterine contractions, resulting in fetal hypoxemia.
D
Maternal hypotension is not associated with SROM.

DIF: Cognitive Level: Comprehension REF: 326
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

6. While evaluating an external monitor tracing of a woman in active labor whose labor is being induced, the nurse notes that the fetal heart rate (FHR) begins to decelerate at the onset of several contractions and returns to baseline before each contraction ends. The nurse should:
a.
Change the womans position.
b.
Discontinue the oxytocin infusion.
c.
Insert an internal monitor.
d.
Document the finding in the patients record.

ANS: D

Feedback
A
The FHR indicates early decelerations, which are not an ominous sign and do not require any intervention. The nurse should simply document these findings.
B
The presence of early decelerations is not an ominous sign and does not require any intervention.
C
The presence of early decelerations is not an ominous sign and does not require any intervention.
D
The FHR indicates early decelerations, which are not an ominous sign and do not require any intervention. The nurse should simply document these findings.

DIF: Cognitive Level: Application REF: 325
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Implementation

7. The nurse providing care for the laboring woman should understand that late fetal heart rate (FHR) decelerations are caused by:
a.
Altered cerebral blood flow.
b.
Umbilical cord compression.
c.
Uteroplacental insufficiency.
d.
Meconium fluid.

ANS: C

Feedback
A
Altered fetal cerebral blood flow would result in early decelerations in the FHR.
B
Umbilical cord compression would result in variable decelerations in the FHR.
C
Uteroplacental insufficiency would result in late decelerations in the FHR.
D
Meconium-stained fluid may or may not produce changes in the fetal heart rate, depending on the gestational age of the fetus and whether other causative factors associated with fetal distress are present.

DIF: Cognitive Level: Knowledge REF: 325
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

8. Perinatal nurses are legally responsible for:
a.
Correctly interpreting fetal heart rate (FHR) patterns, initiating appropriate nursing interventions, and documenting the outcomes.
b.
Greeting the patient on arrival, assessing her, and starting an intravenous line.
c.
Applying the external fetal monitor and notifying the care provider.
d.
Making sure that the woman is comfortable.

ANS: A

Feedback
A
Nurses who care for women during childbirth are legally responsible for correctly interpreting FHR patterns, initiating appropriate nursing interventions based on those patterns, and documenting the outcomes of those interventions.
B
This may be an activity that a nurse performs, but it is not an activity for which the nurse is legally responsible.
C
This may be an activity that a nurse performs, but it is not an activity for which the nurse is legally responsible.
D
This is one aspect of caring for a woman in labor, but it is not an activity for which the nurse is legally responsible.

DIF: Cognitive Level: Comprehension REF: 329
OBJ: Client Needs: Safe and Effective Care Environment
TOP: Nursing Process: Assessment, Planning, Implementation

9. As a perinatal nurse you realize that a fetal heart rate that is tachycardic, is bradycardic, or has late decelerations or loss of variability is nonreassuring and is associated with:
a.
Hypotension.
b.
Cord compression.
c.
Maternal drug use.
d.
Hypoxemia.

ANS: D

Feedback
A
Fetal bradycardia may be associated with maternal hypotension.
B
Fetal variable decelerations are associated with cord compression.
C
Maternal drug use is associated with fetal tachycardia.
D
Nonreassuring heart rate patterns are associated with fetal hypoxemia.

DIF: Cognitive Level: Analysis REF: 318
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

10. A new patient and her partner arrive on the labor, delivery, recovery, and postpartum unit for the birth of their first child. You apply the electronic fetal monitor (EFM) to the woman. Her partner asks you to explain what is printing on the graph, referring to the EFM strip. He wants to know what the babys heart rate should be. Your best response is:
a.
Dont worry about that machine; thats my job.
b.
The top line graphs the babys heart rate. Generally the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor.
c.
The top line graphs the babys heart rate, and the bottom line lets me know how strong the contractions are.
d.
Your doctor will explain all of that later.

ANS: B

Feedback
A
This discredits the partners feelings and does not provide the teaching he is requesting.
B
This statement educates the partner about fetal monitoring and provides support and information to alleviate his fears.
C
This statement provides inaccurate information and does not address the partners concerns about the fetal heart rate. The EFM graphs the frequency and duration of the contractions, not the intensity.
D
Nurses should take every opportunity to provide patient and family teaching, especially when information is requested.

DIF: Cognitive Level: Application REF: 317
OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Planning

11. According to standard professional thinking, nurses should auscultate the fetal heart rate (FHR):
a.
Every 15 minutes in the active phase of the first stage of labor in the absence of risk factors.
b.
Every 20 minutes in the second stage, regardless of whether risk factors are present.
c.
Before, during, and after a contraction.
d.
More often in a womans first pregnancy.

ANS: C

Feedback
A
In the active phase of the first stage of labor, the FHR should be auscultated every 30 minutes if no risk factors are involved; with risk factors it should be auscultated every 15 minutes.
B
In the second stage of labor the FHR should be auscultated every 15 minutes if no risk factors are involved; with risk factors it should be auscultated every 5 minutes.
C
The FHR should be auscultated before, during, and after a contraction to identify the response of the fetal heart to uterine contractions.
D
The fetus of a first-time mother is automatically at greater risk.

DIF: Cognitive Level: Comprehension REF: 319
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Implementation

12. The nurse providing care for the laboring woman should understand that amnioinfusion is used to treat:
a.
Variable decelerations.
b.
Late decelerations.
c.
Fetal bradycardia.
d.
Fetal tachycardia.

ANS: A

Feedback
A
Amnioinfusion is used during labor to either dilute meconium-stained amniotic fluid or supplement the amount of amniotic fluid to reduce the severity of variable decelerations caused by cord compression.
B
Amnioinfusion has no effect on late decelerations.
C
Amnioinfusion has no effect on fetal bradycardia.
D
Amnioinfusion has no effect on fetal tachycardia.

DIF: Cognitive Level: Knowledge REF: 332
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Implementation

13. What is an advantage of external electronic fetal monitoring?
a.
The ultrasound transducer can accurately measure short-term variability and beat-to-beat changes in the fetal heart rate.
b.
The tocotransducer can measure and record the frequency, regularity, intensity, and approximate duration of uterine contractions (UCs).
c.
The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor.
d.
Once correctly applied by the nurse, the transducer need not be repositioned even when the woman changes positions.

ANS: C

Feedback
A
These short-term changes cannot be measured with this technology.
B
The tocotransducer cannot measure and record the intensity of UCs.
C
This is especially true when the membranes are intact.
D
The transducer must be repositioned when the woman or fetus changes position.

DIF: Cognitive Level: Comprehension REF: 320
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Implementation

14. During labor a fetus with an average heart rate of 135 beats/min over a 10-minute period would be considered to have:
a.
Bradycardia.
b.
A normal baseline heart rate.
c.
Tachycardia.
d.
Hypoxia.

ANS: B

Feedback
A
Bradycardia is a fetal heart rate (FHR) below 110 beats/min for 10 minutes or longer.
B
The baseline heart rate is measured over 10 minutes; a normal range is 110 to 160 beats/min.
C
Tachycardia is an FHR over 160 beats/min for 10 minutes or longer.
D
Hypoxia is an inadequate supply of oxygen; no indication of this condition exists with a baseline heart rate in the normal range.

DIF: Cognitive Level: Knowledge REF: 317
OBJ: Client Needs: Integrity: Physiologic Adaptation TOP: Nursing Process: Assessment

15. Nurses should be aware that accelerations in the fetal heart rate:
a.
Are indications of fetal well-being when they are periodic.
b.
Are greater and longer in preterm gestations.
c.
Are usually seen with breech presentations when they are episodic.
d.
May visibly resemble the shape of the uterine contraction.

ANS: D

Feedback
A
Periodic accelerations occur with uterine contractions (UCs) and usually are seen with breech presentations. Episodic accelerations occur during fetal movement and are indications of fetal well-being.
B
Preterm accelerations peak at 10 beats/min above the baseline and last for at least 10 seconds, not 15 seconds.
C
Periodic accelerations occur with UCs and usually are seen with breech presentations. Episodic accelerations occur during fetal movement and are indications of fetal well-being.
D
They may resemble the shape of the uterine contraction or may be spikelike.

DIF: Cognitive Level: Knowledge REF: 324, 325
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

16. When using intermittent auscultation (IA) for fetal heart rate, nurses should be aware that:
a.
They can be expected to cover only two or three patients when IA is the primary method of fetal assessment.
b.
The best course is to use the descriptive terms associated with electronic fetal monitoring (EFM) when documenting results.
c.
If the heartbeat cannot be found immediately, a shift must be made to EFM.
d.
Ultrasound can be used to find the fetal heartbeat and reassure the mother if initial difficulty was a factor.

ANS: D

Feedback
A
When used as the primary method of fetal assessment, auscultation requires a nurse-to-patient ratio of one to one.
B
Documentation should use only terms that can be numerically defined; the usual visual descriptions of EFM are inappropriate.
C
Locating fetal heartbeats often takes time. Mothers can be reassured verbally and by the ultrasound pictures if ultrasound is used to help locate the heartbeat.
D
Locating fetal heartbeats often takes time. Mothers can be reassured verbally and by the ultrasound pictures if ultrasound is used to help locate the heartbeat.

DIF: Cognitive Level: Comprehension REF: 319
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment, Planning

17. Which deceleration of the fetal heart rate would NOT require the nurse to change the maternal position?
a.
Early decelerations
b.
Late decelerations
c.
Variable decelerations
d.
It is always a good idea to change the womans position.

ANS: A

Feedback
A
Early decelerations (and accelerations) generally do not need any nursing intervention.
B
Late decelerations suggest that the nurse should change the maternal position (lateral); variable decelerations also require a maternal position change (side to side).
C
Late decelerations suggest that the nurse should change the maternal position (lateral); variable decelerations also require a maternal position change (side to side).
D
Although changing positions throughout labor is recommended, it is not required in response to early decelerations.

DIF: Cognitive Level: Comprehension REF: 325
OBJ: Client Needs: Physiologic Integrity
TOP: Nursing Process: Assessment, Planning

18. When assessing the relative advantages and disadvantages of internal and external electronic fetal monitoring, nurses should be aware that both:
a.
Can be used when membranes are intact.
b.
Measure the frequency, duration, and intensity of uterine contractions.
c.
May need to rely on the woman to indicate when uterine activity (UA) is occurring.
d.
Can be used during the antepartum and intrapartum periods.

ANS: D

Feedback
A
For internal monitoring the membranes must have ruptured, and the cervix must be sufficiently dilated.
B
Internal monitoring measures the intensity of contractions; external monitoring cannot do this.
C
With external monitoring, the woman may need to alert the nurse that UA is occurring; internal monitoring does not require this.
D
External monitoring can be used in both periods; internal monitoring can be used only in the intrapartum period.

DIF: Cognitive Level: Comprehension REF: 320
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

19. A nurse might be called on to stimulate the fetal scalp:
a.
As part of fetal scalp blood sampling.
b.
In response to tocolysis.
c.
In preparation for fetal oxygen saturation monitoring.
d.
To elicit an acceleration in the fetal heart rate (FHR).

ANS: D

Feedback
A
Fetal scalp blood sampling involves swabbing the scalp with disinfectant before a sample is collected. The nurse would stimulate the fetal scalp to elicit an acceleration of the FHR.
B
Tocolysis is relaxation of the uterus. The nurse would stimulate the fetal scalp to elicit an acceleration of the FHR.
C
Fetal oxygen saturation monitoring involves the insertion of a sensor. The nurse would stimulate the fetal scalp to elicit an acceleration of the FHR.
D
The scalp can be stimulated using digital pressure during a vaginal examination.

DIF: Cognitive Level: Application REF: 330
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Implementation

20. In assisting with the two factors that have an effect on fetal status (i.e., pushing and positioning), nurses should:
a.
Encourage the womans cooperation in avoiding the supine position.
b.
Advise the woman to avoid the semi-Fowler position.
c.
Encourage the woman to hold her breath and tighten her abdominal muscles to produce a vaginal response.
d.
Instruct the woman to open her mouth and close her glottis, letting air escape after the push.

ANS: A

Feedback
A
The woman should maintain a side-lying position.
B
The semi-Fowler position is the recommended side-lying position with a lateral tilt to the uterus.
C
This is the Valsalva maneuver, which should be avoided.
D
Both the mouth and glottis should be open, letting air escape during the push.

DIF: Cognitive Level: Comprehension REF: 332
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Implementation

21. A number of methods for assisting in the assessment of fetal well-being have been developed for use in conjunction with electronic fetal monitoring. These various technologies assist in supporting interventions for a nonreassuring fetal heart rate pattern when necessary. The labor and delivery nurse should be aware that one of these modalities, fetal oxygen saturation monitoring, includes the use of:
a.
A fetal acoustic stimulator.
b.
Fetal blood sampling.
c.
Fetal pulse oximetry.
d.
Umbilical cord acid-base determination.

ANS: C

Feedback
A
Stimulation of the fetus is done in an effort to elicit a fetal heart rate response. The two acceptable methods of achieving this result are the use of fetal scalp stimulation or vibroacoustic stimulation. Vibroacoustic stimulation is performed by using an artificial larynx or fetal acoustic stimulation device over the fetal head for 1 or 2 seconds.
B
Sampling of the fetal scalp blood was designed to assess fetal pH, O2, and CO2. The sample is obtained from the fetal scalp through a dilated cervix. This test is usually done in tertiary care centers, where results can be immediately available. It has recently fallen out of favor because test results vary widely.
C
Continuous monitoring of the fetal O2 saturation by fetal pulse oximetry is a method that was approved for clinical use in 2000 by the Food and Drug Administration. This process works in a method similar to obtaining a pulse oximetry in a child or adult. A specially designed sensor is inserted into the uterus and lies against the fetuss temple or cheek. A normal result is 30% to 70%, with 30% being the cutoff for further intervention.
D
This test is not completed until after birth. Cord blood is drawn from the umbilical artery and tested for pH, O2, and CO2.

DIF: Cognitive Level: Knowledge REF: 331
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

MULTIPLE RESPONSE

1. In assessing the immediate condition of the newborn after birth, a sample of cord blood may be a useful adjunct to the Apgar score. Cord blood is then tested for pH, carbon dioxide, oxygen, and base deficit or excess. Clinical situations that warrant this additional testing include (choose all that apply):
a.
Low 5 minute Apgar score.
b.
IUGR.
c.
Maternal thyroid disease.
d.
Intrapartum fever.
e.
Multiple gestation.
f.
Abnormal fetal heart rate tracing.

ANS: A, B, C, D, E, F

Feedback
Correct
ACOG suggests obtaining cord blood values in ALL of these clinical situations. Samples can be drawn from both the umbilical artery and the umbilical vein. Results may indicate that fetal compromise has occurred.
Incorrect
None of the above.

DIF: Cognitive Level: Comprehension REF: 331
OBJ: Client Needs: Physiologic Integrity
TOP: Nursing Process: Planning, Implementation

Write a review

Your Name:


Your Review: Note: HTML is not translated!

Rating: Bad           Good

Enter the code in the box below:



Welcome to Test bank Fan

 

Once the order is placed, the order will be delivered to your email less than 24 hours, mostly within 4 hours. 

If you have questions, you can contact us here