ob 17 14 13

6. What are the most common cause(s) of early postpartum hemorrhage? (Select all that apply.) 1. Retained placental fragments 2. Subinvolution 3. Uterine atony 4. Laceration 5. Infection

6. Correct answers: 3, 4 Rationale: The most common causes of early postpartum hemorrhage are uterine atony and laceration. Late postpartum hemorrhage (secondary postpartum hemorrhage) is caused by retained placental fragments or subinvolution. Coagulation defects and infection can also result in postpartum hemorrhage. Page reference: 343

7. A pregnant woman is diagnosed with bacterial vaginosis (BV). The drug of choice to treat BV is: 1. Clindamycin 2. Amoxicillin 3. Topical hydrocortisone 4. Tetracycline

7. Correct answer: 1 Rationale: Oral metronidazole or clindamycin is the drug of choice to treat bacterial vaginosis. Page references: 273, 274

5. A woman in the labor and birth unit is undergoing induction with oxytocin (Pitocin). If the nurse notices late decelerations of the fetal heart rate, the first action should be to: 1. Notify the physician. 2. Assist the patient into left-side lying position. 3. Discontinue the oxytocin (Pitocin). 4. Apply oxygen via nasal cannula.

5. Correct answer: 3 Rationale: Oxytocin is discontinued immediately, and the primary health care provider is notified if uterine hyperstimulation or nonreassuring fetal heart rate occurs. Page reference: 291

5. It is suspected that a woman on the postpartum unit has a deep vein thrombosis. The nurse can expect the possibility of which diagnostic test (s) to be ordered to confirm this diagnosis: (Select all that apply.) 1. Computed tomography 2. Magnetic resonance angiography 3. Ultrasound 4. X-ray

5. Correct answer: 4 Rationale: Computed tomography or magnetic resonance angiography is helpful to show the presence of a thrombus, and ultrasound or duplex scanning may be used. Page reference: 349

6. The goal of glucose monitoring in a woman with gestational diabetes is to maintain a level between: 1. 60 and 80 mg/dL 2. 80 and 120 mg/dL 3. 100 and 130 mg/dL 4. 120 and 140 mg/dL

6. Correct answer: 2 Rationale: The goal of glucose monitoring in the woman with gestational diabetes mellitus (GDM) is to maintain a level between 80 and 120 mg/dL. Page reference: 271

7. Which clinical manifestation(s) would indicate preterm labor? (Select all that apply.) 1. Thigh pain 2. Vaginal bleeding 3. Calf cramping 4. Low back pain 5. Nausea

7. Correct answers: 1, 2, 4 Rationale: Clinical manifestations of preterm labor are more subtle than for term labor and include uterine cramping (menstrual-like cramps), abdominal cramping (with or without nausea, vomiting, or diarrhea), any vaginal bleeding, change in vaginal discharge, vaginal or pelvic pressure, low back pain, and thigh pain (intermittent or persistent). Page reference: 281

7. What are the three leading causes of maternal death? (Select all that apply.) 1. Pulmonary embolism 2. Endometritis 3. Hemorrhage 4. Gestational hypertension 5. Necrotizing fasciitis

7. Correct answers: 1, 3, 4 Rationale: Pulmonary embolism is reported as one of the three leading causes of maternal death, along with hemorrhage and gestational hypertension, and is a feared complication of deep vein thrombosis (DVT). Page reference: 349

8. Management of placenta previa depends on which characteristic(s)? (Select all that apply.) 1. Maternal age 2. Classification of previa 3. Fetal heart rate 4. Gestational age of the fetus 5. Maternal vital signs

8. Correct answers: 2, 4 Rationale: Management of placenta previa depends on the classification of previa and gestational age of the fetus. Page reference: 255

6. A laceration of the perineum where the anal sphincter muscles and muscles of the perineum are torn is classified as a: 1. First-degree laceration 2. Second-degree laceration 3. Third-degree laceration 4. Fourth-degree laceration

6. Correct answer: 3 Rationale: In a third-degree laceration, the anal sphincter muscles and muscles of the perineum are torn. A first-degree laceration extends through the skin and into the mucous membrane. A second-degree laceration extends farther, reaching the muscles of the perineal body. A fourth-degree laceration reaches into the anal sphincter muscles and anterior wall of the rectum. Page reference: 291

4. The nonpharmacologic method of cervical ripening that involves rupturing the membranes by piercing with an amniotic hook is called: 1. Stripping of membranes 2. Amniotomy 3. Mechanical dilation 4. Prostaglandin gel application

4. Correct answer: 2 Rationale: Amniotomy (artificial rupture of membranes) involves the membranes being ruptured by piercing with an amniotic hook. Page reference: 290

4. The physician has ordered an accurate assessment of blood loss on a postpartum patient. When subtracting the weight of a dry perineal pad from a saturated pad the nurse notes a weight of 7 g. This blood loss would be recorded on the liquid section of the output record as: 1. 7 g 2. 7 mL 3. 0.07 kg 4. 3.5 cc

4. Correct answer: 2 Rationale: An accurate assessment of blood loss is important. Blood loss can be assessed by weighing the perineal pad (1 g = 1 mL, subtracting weight of dry pad from saturated pad). Page reference: 346

5. The highest incidence of hyperemesis gravidarum occurs with: 1. Adolescent pregnancies 2. First pregnancies 3. Advanced maternal age 4. Gestational diabetes

5. Correct answer: 2 Rationale: The highest incidence of hyperemesis gravidarum occurs with the first pregnancy, multifetal pregnancy, and hydatidiform mole. Page reference: 268

1. A woman experiencing signs and symptoms of preterm labor is admitted to the labor and birth unit. Baseline maternal vital signs are recorded as follows: T 101.5, P 110, R 30, and BP 134/80. These vital signs strongly suggest: 1. Fetal distress 2. Amniotic fluid infection 3. Hypovolemia 4. Preeclampsia

1. Correct answer: 2 Rationale: Baseline maternal vital signs are important and may provide clues of infection. Tachycardia and elevation of temperature can be early signs of amniotic fluid infection. Page references: 282, 283

1. Education for a woman following diagnosis of gestational trophoblastic disease would include: (Select all that apply.) 1. The hCG titers will be monitored for a year. 2. Pregnancy can be attempted as soon as hCG levels begin to decrease. 3. Subsequent pregnancies should be normal because there is a low risk of recurrence. 4. Treatment begins with the evacuation of the mole by suction aspiration.

1. Correct answer: 2 Rationale: The woman is monitored for a year; if the hCG serum titers are within normal limits, the woman may be assured that she is healthy. The woman often takes oral contraceptives to prevent another pregnancy and to allow the hCG levels to return to normal. If the woman becomes pregnant immediately, it would make it impossible to monitor the decline in hCG, which is the significant part of follow-up care. Psychological support should be provided in relation to the pregnancy loss, and another pregnancy should be delayed for at least 1 year. Page reference: 254

1. Postpartum hemorrhage is traditionally defined as the loss of more than 500 mL after an uncomplicated vaginal birth or: 1. 600 mL after a cesarean birth 2. 800 mL after a cesarean birth 3. 1000 mL after a cesarean birth 4. 1200 mL after a cesarean birth

1. Correct answer: 3 Rationale: Postpartum hemorrhage is traditionally defined as the "loss of more than 500 mL of blood after an uncomplicated vaginal birth or 1000 mL after a cesarean birth." Page reference: 343

2. Labor with uterine contractions of poor quality that are painful, out of proportion to their intensity, do not cause cervical dilation or effacement, and are usually uncoordinated and frequent is known as: 1. Hypotonic uterine dysfunction 2. Cephalopelvic disproportion 3. Hypertonic uterine dysfunction 4. Precipitate labor

2. Correct answer: 3 Rationale: Hypertonic uterine dysfunction refers to a labor with uterine contractions of poor quality that are painful, out of proportion to their intensity, do not cause cervical dilation or effacement, and are usually uncoordinated and frequent. Page reference: 285

2. A condition resulting from overstimulation of the normal coagulation process in which a coagulation defect prevents blood from clotting is: 1. Abruptio placentae 2. Thrombocytopenia 3. Eclampsia 4. Disseminated intravascular coagulation (DIC)

2. Correct answer: 4 Rationale: A condition in which a coagulation defect prevents blood from clotting, resulting from overstimulation of the normal coagulation process, is disseminated intravascular coagulation (DIC). Page reference: 257

2. When performing a morning assessment on a 1-day postpartum mother, the nurse notes excessive bright red vaginal bleeding with uterine fundus firmly contracted. The nurse suspects: 1. Hematoma 2. Placenta accreta 3. Disseminated intravascular coagulation 4. Lacerations

2. Correct answer: 4 Rationale: Lacerations are suspected when excessive bleeding occurs and the uterine fundus is firmly contracted. Bleeding from the vagina is usually bright red, compared with lochia, which is dark red and not profuse or continuous. Signs of shock may occur. Page references: 344, 345

3. The most common example of malpresentation is: 1. Breech presentation 2. Transverse lie presentation 3. Shoulder presentation 4. Face presentation

3. Correct answer: 1 Rationale: Breech is the most common example of malpresentation. It occurs in approximately 3% to 4% of all births. Page reference: 287

3. A pregnant woman in the thirtieth week of gestation is diagnosed with gestational hypertension (GH). Which statement made by the woman indicates a need for further education regarding management of GH? 1. "I should maintain an adequate diet and fluid intake." 2. "I will remain on strict bed rest for the remainder of my pregnancy." 3. "I must have a mode of transportation available at all times." 4. "I should not restrict sodium."

3. Correct answer: 2 Rationale: Strict bedrest is no longer advocated with the diagnosis of gestational hypertension (GH), but restriction of activity is recommended. The woman with GH should maintain an adequate diet and fluid intakes. Requirements to remain at home include available telephone communication, transportation available at all times, and commitment to frequent clinic visits. Sodium should not be restricted; however, excessive intake of foods with high amounts of sodium, such as pickles, olives, and tortilla chips, should be avoided. Page references: 261, 262

3. The first action with uterine atony should be to: 1. Assess for bladder distention 2. Massage the uterus until firm 3. Express clots 4. Administer oxytocin intravenously

3. Correct answer: 2 Rationale: The first nursing action with uterine atony should be to massage the uterus until firm and to express clots that may have accumulated in the uterus. It is critical not to try to express clots until the uterus is firmly contracted. Pushing on an uncontracted uterus can invert the uterus and cause a massive hemorrhage. If the uterus does not stay contracted, the health care provider may order an intravenous infusion of dilute oxytocin. Page reference: 346

4. A pregnant woman with a cardiac history is receiving anticoagulant therapy and has been instructed to restrict foods high in vitamin K. Which food should the nurse instruct the woman to restrict? 1. Spinach 2. Cheese 3. Chicken 4. Bananas

4. Correct answer: 1 Rationale: The woman with a cardiac history who is receiving anticoagulant therapy may need to restrict foods high in vitamin K, such as raw, dark green, leafy vegetables. Page reference: 266