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1.

Nurse Olive asseses a client for evidence of postpartum hemorrhage during


the third stage of labor. Early signs of this postpartum complication include:
a.
an increased pulse rate, decreased respiratory rate, and increased blood
pressure.
b.
a decreased pulse rate, increased respiratory rate, and increased blood
pressure.
c.
a decreased pulse rate, decreased respiratory rate, and increased blood
pressure.
d.
an increased pulse rate, increased respiratory rate, and decreased blood
pressure.
2. Which of the following is not true regarding the third stage of labor?
a. Care should be taken in the administration of bolus of oxytocin because it can
cause hypertension
b. Signs of placental separation are lengthening of the cord, sudden gush of
blood and sudden change in shape of the uterus
c. It ranges from the time of expulsion of the fetus to the delivery of the placenta
d. The placenta is delivered approximately 5-15 minutes after delivery of the
baby
3. A direct cause of mis-management of the third stage of labor is:
a. inversion of the uterus
b. cord prolapse
c. prolonged labor
d. all of these
4. A client has just started the third stage of labor. Which of the following nursing
actions have priority at this time?
1. Encouraging the client to push
2. Administration of an oxytocic medication
3. Physical assessment of the infant
4. Promotion of the bonding process
5. While assisting a multiparous client to the bathroom for the first time 1 hour
after a vaginal delivery of a viable neonate, the nurse notes that the client's urine
has two small blood clots in the measuring container. Which of the following
should the nurse do next?"
a.) Massage the client's fundus vigorously.
b.) Ask the client if she passed clots with her previous deliveries.
c.) Review the client's records for the length of the 3rd stage of labor.

d.) Document this observation as a normal finding.

48.
a.
b.
c.
d.

Nurse Julia is aware that Labor is divided into how many stages?
Five
Three
Two
Four

49.
Jannah, who is in labor receives epidural anesthesia. The nurse should
assess carefully for which adverse reaction to the anesthetic agent?
a. Hypotensive crisis
b. Fetal tachycardia
c. Renal toxicity
d. Increased beat-to-beat variability in the fetal heart rate (FHR)
50. To promote comfort during labor, Nurse Michelle advises a client to assume
certain positions and avoid others. Which position may cause maternal
hypotension and fetal hypoxia?
a. Lateral position
b. Squatting position
c. Supine position
d. Standing position

Rationale
1. Answer D. An increased pulse rate followed by an increased respiratory rate
and decreased blood pressure may be the first signs of postpartum hemorrhage
and hypovolemic shock.
2. Answer A. Care should be taken in the administration of bolus of oxytocin
because it can cause hypertension
3. Answer A. inversion of the uterus
4. Answer C. The infant's physical condition is a priority at on eand five minutes
after delivery. The physical assessment done at this time is known as Apgar
scoring.
5. Answer D. The passage of two small blood clots from a multiparous woman 1
hour after a vaginal delivery is not an unusual occurrence. The nurse should
continue to monitor the client and document this as a normal finding. The nurse

should never massage a postpartum client's fundus vigorously because of the


risk for uterine inversion and discomfort to the mother. Asking whether the client
passed clots with her previous deliveries is irrelevant. The length of the third
stage of labor has no relation to whether or not the client passes clots.
48. Answer D. Labor is divided into four stages: first stage, onset of labor to full
dilation; second stage, full dilation to birth of the baby; third stage, birth of the
placenta; and fourth stage, 1-hour postpartum. The first stage is divided into
three phases: early, active, and transition.
49.
Answer A. Hypotensive crisis may occur after epidural anesthesia
administration as the anesthetic agent spreads through the spinal canal, blocking
sympathetic innervation. Other signs and symptoms of hypotensive crisis
associated with epidural anesthesia may include fetal bradycardia (not
tachycardia) and decreased (not increased) beat-to-beat variability in the FHR.
Urine retention, not renal toxicity, may occur during the postpartum period.
50. Answer C. The supine position causes compression of the clients aorta and
inferior vena cava by the fetus. This, in turn, inhibits maternal circulation, leading
to maternal hypotension and, ultimately, fetal hypoxia. The other positions
promote comfort and aid labor progress. For instance, the lateral, or side-lying,
position improves maternal and fetal circulation, enhances comfort, increases
maternal relaxation, reduces muscle tension, and eliminates pressure points. The
squatting position promotes comfort by taking advantage of gravity. The standing
position also takes advantage of gravity and aligns the fetus with the pelvic
angle.

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