OB Chapter 12,15
A client has just received synthetic prostaglandins for the induction of labor. The nurse plans to monitor the client for which of the following side effects? 1. Nausea and uterine tetany. 2. Hypertension and vaginal bleeding. 3. Urinary retention and severe headache. 4. Bradycardia and hypothermia.
1
The triage nurse in an obstetric clinic received the following four messages during the lunch hour. Which of the women should the nurse telephone first? 1. "My section incision from last week is leaking a whitish yellow discharge and I have a fever. What should I do?" 2. "I am 39 weeks pregnant with my first baby. I am having contractions about every twenty minutes." 3. "My boyfriend and I had intercourse this morning and our condom broke. What should we do?" 4. "I started my period yesterday. I need some medicine for these terrible menstrual cramps."
1
A woman is being interviewed by a triage nurse at a medical doctor's office. Which of the following signs/symptoms by the client would warrant the nurse to suggest that a pregnancy test be done? Select all that apply. 1. Amenorrhea. 2. Fever. 3. Fatigue. 4. Nausea. 5. Dysuria.
1, 3, 4
A woman is admitted to the labor and delivery unit with active tuberculosis. She has not been under a physician's care and is not on medication. Which of the following actions should the nursery nurse perform when the neonate is delivered? 1. Isolate the baby from the other babies in a special care nursery. 2. Keep the baby in the regular care nursery but separated from the mother. 3. Isolate the baby with the mother in the mother's room. 4. Obtain an order from the doctor for antituberculosis medications for the baby.
2
The nurse is caring for a client in labor and delivery with the following history: G2 P1000, 39 weeks' gestation in transition phase, FH 135 with early decelerations. The client states, "I'm so scared. Please make sure the baby is OK!" Which of the following responses by the nurse is appropriate? 1. "There is absolutely nothing to worry about." 2. "The fetal heart rate is within normal limits." 3. "How did your first baby die?" 4. "Did your first baby die during labor?"
2
A certified nursing assistant (CNA) is working with a registered nurse in the neonatal nursery. It would be appropriate for the nurse to delegate which of the following actions to the assistant? 1. Admission assessment on a newly delivered baby. 2. Patient teaching of a neonatal sponge bath. 3. Placement of a bag on a baby for urine collection. 4. Hourly neonatal blood glucose assessments.
3
A patient is placed on bedrest at home for mild pre-eclampsia at 38 weeks' gestation. Which of the following must the nurse teach the patient regarding her condition? 1. Eat a sodium-restricted diet. 2. Check her temperature 4 times daily. 3. Report swollen hands and face. 4. Limit fluids to 1 liter per day.
3
A fetus is in the LOA position in utero. Which of the following findings would the nurse observe when doing Leopold maneuvers? 1. Hard, round object in the fundal region. 2. Flat object above the symphysis pubis. 3. Soft, round object on the left side of the uterus. 4. Small objects on the right side of the uterus.
4
A woman is seeking counseling regarding tubal ligation. Which of the following should the nurse include in her discussion? 1. The woman will no longer menstruate. 2. The surgery should be done when the woman is ovulating. 3. The surgery is easily reversible. 4. The woman will be under anesthesia during the procedure.
4
The nurse is caring for a client, 37 weeks' gestation, who was just told that she is group B streptococci + (positive). The client states, "How could that happen? I only have sex with my husband. Will my baby be OK?" Based on this information, which of the following should the nurse communicate to the client? 1. The client's partner must have acquired the bacteria during a sexual encounter. 2. The bacteria do not injure babies, but they could cause the client to have a bad sore throat. 3. The client is at high risk for developing pelvic inflammatory disease from the bacteria. 4. Antibiotics will be administered during labor to prevent vertical transmission of the bacteria.
4
A woman gave birth to a 3200 g baby girl with an estimated gestational ageof 40 weeks. The baby is 1 hour of age. In preparation of giving the baby an injection of vitamin K, the nurse will: a. Explain to the parents the action of the medication and answer their questions. b. Remove the neonate from the room so the parents will not be distressed byseeing the injection. c. Completely undress the neonate to identify the injection site. d. Replace needle with a 21 gauge 5/8 needle.
A
An infant admitted to the newborn nursery has a blood glucose level of 55mg/dL. Which of the following actions should the nurse perform at this time? a. Provide the baby with routine feedings. b. Assess the baby's blood pressure. c. Place the baby under the infant warmer. d. Monitor the baby's urinary output.
A
The nurse has just completed discharge teaching for a primiparous patient. Which statement by the patient indicates to the nurse understanding of discharge instructions following vaginal delivery of a term infant? A. "I will call my doctor if my uterus is squishy when I massage it." B. "I will experience heavy bleeding for the first week" C. "I should change my peripad twice a day." D. "I might notice a foul smell to my discharge."
A
The nurse is about to elicit the rooting reflex on a newborn baby. Which ofthe following responses should the nurse expect to see? a. When the cheek of the baby is touched, the newborn turns toward the sidethat is touched. b. When the lateral aspect of the sole of the baby's foot is stroked, the toesextend and fan outward. c. When the baby is suddenly lowered or startled, the neonate's armsstraighten outward and the knees flex. d. When the newborn is supine and the head is turned to one side, the arm onthat same side extends.
A
The nurse places the newborn on the mother skin-to-skin immediately after birth. What is the most appropriate teaching for the mother at this time? A. Encourage the mother to initiate breastfeeding and provide support. B. Provide education for the Hepatitis B vaccine before administration. C. Teach the importance of bonding and rooming-in. D. Discuss the methods of heat loss and provide examples.
A
The nursery nurse notes the presence of diffuse edema on a baby girl's head. Review of the birth record indicates that her mother experienced a prolonged labor and difficult childbirth. By the second day of life, the edema has disappeared. The nurse documents the following condition in the infant'schart. a. Caput succedaneum b. Cephalhematoma c. Subperiosteal hemorrhage d. Epstein pearls
A
To accurately measure the neonate's head, the nurse places the measuring tape around the head: a. Just above the ears and eyebrows b. Middle of the ear and over the eyes c. Middle of the ear and over the bridge of the nose d. Just below the ears and over the upper lip
A
Which of the following breath sounds are normal to hear in the neonateduring the first few hours postbirth? a. Scattered crackles b. Wheezes c. Stridor d. Grunting
A
A patient on the postpartum unit reports passing an egg-sized clot. What are the priority nursing interventions for this patient? Select all that apply. A. Weigh the clot. B. Report the findings to the physician or midwife. C. Assist the patient to the bathroom. D. Administer Oxytocin 10U IM. E. Call for rapid response
A, B
The nurse is assessing a 4-hour-old neonate. What behaviors would the nurse expect the newborn to exhibit? Select all that apply. A. Passage of meconium B. Responsive to external stimuli C. Sleepy and uninterested in breastfeeding D. Grunting and irregular respirations E. Spontaneous Moro reflexes
A, B
The Mother Baby educator is orienting a group of new nurses and discussing the hepatic system. The educator determines the group understands bilirubin production when choosing which statements as correct? Select all that apply. A. The neonate produces more bilirubin after birth due to an increase in RBC production." B. "Direct (conjugated) bilirubin is a water-soluble substance." C. "Hyperbilirubinemia may occur from immature liver function." D. "All neonates develop physiological jaundice from the increased production of RBCs." E. "Indirect (unconjugated) bilirubin can be excreted in the urine and stool."
A, B, C
The nurse is teaching an expectant parent class about sleep/awake states of newborn behavior. Which statement is correct regarding these infant states? Select all that apply. A. During light sleep, you may notice the baby breathing irregularly and this is normal. B. During the alert state, the baby will be wide awake with little movement. C. During the drowsy state, breathing is slow and regular and the baby is easily aroused. D. When crying, the baby will be difficult to calm down and feed. E. During eyes open, the baby may move more but not easily startled.
A, B, D
A multiparous patient asks the nurse why she is feeling contractions 8 hours after giving birth. What information should the nurse include in her teaching? Select all that apply. A. The intensity of the afterpains should decrease in a few days." B. "The pains are from your abdominal muscles stretching during pregnancy." C. "You probably don't remember feeling afterpains after your first baby." D. "The afterpains are more intense because you are not breastfeeding." E. "Because you had Pitocin during labor, you will feel more contractions after delivery."
A, C
A G4P4 patient who is 6 hours post-delivery is complaining of severe cramp-like uterine pains. What is a therapeutic nursing response? A. The cramping should go away when you start breastfeeding." B. "The pains are caused by your uterus contracting and should get better in a few days." C. "Afterpains are usually the worse with your first baby." D. "The contractions will subside over the next 6 weeks as your uterus goes back to its normal size."
B
A certified nursing assistant (CNA) is working with a registered nurse (RN) in the neonatal nursery. Which of the following actions would be appropriate forthe nurse to delegate to the CNA? a. Admit a newly delivered baby to the nursery. b. Bathe and weigh a 3-hour-old baby. c. Provide discharge teaching to the mother of a 4-day-old baby. d. Interpret a bilirubin level reported by the laboratory.
B
A client is concerned because her 2-hour-old newborn is sleeping skin-to-skin and will not breastfeed. Which response by the nurse is correct to explain this behavior? A. The medication you received in labor is affecting the baby's ability to stay awake." B. "This is a normal response after birth and may last an hour or two." C. "The baby could be sleepy because of a low glucose level. Try to wake the baby up and breastfeed." D. "We can give the baby a bath to wake the baby up."
B
A nurse is doing a newborn assessment on a new admission to the nursery.Which of the following actions should the nurse make when evaluating the baby for developmental dysplasia of the hip? a. Grasp the inner aspects of the baby's calves with thumbs and forefingers. b. Gently abduct the baby's thighs. c. Palpate the baby's patellae to assess for subluxation of the bones. d. Dorsiflex the baby's feet.
B
A postpartum nurse caring for a patient 3 days post-delivery notes brown vaginal discharge. How should the nurse document this finding in the electronic health record? A. Lochia rubra B. Lochia serosa C. Lochia alba D. Brown vaginal discharge
B
A postpartum nurse is caring for a G1P1 patient 24 hours post-vaginal delivery. What is the priority action for the nurse when preparing to assess for uterine involution? A. Assist the woman to a supine. B. Instruct the woman to void. C. Reassure the woman that she will not feel pain during the procedure. D. Notify the woman that you will be visualizing her perineum.
B
A postpartum nurse is caring for multiple patients on the mother-baby unit. Which patient should the nurse evaluate first? A. A G1P1 who gave birth 30 minutes ago and reports uncontrollable shaking B. A G6P5 who gave birth 6 hours ago and reports passing a basketball-sized blood clot C. A G3P1 who is 3 days post-op cesarean section and reports cracked and bloody nipples D. A G2P1 who is 2 days post-op cesarean section and reports 7/10 abdominal pain
B
Four newborns have been admitted to the nursery. Which of the newborns should the nurse assess first? A. Newborn with respiratory rate 36, oxygen saturation 98% B. Newborn with Apgar 8/9, weight 4590 grams C. Newborn with Apgar 6/8, temperature 97.9 degrees F D. Newborn with heart rate 156, intrauterine growth restriction (IUGR)
B
The instructor is teaching the role of the hepatic system in blood coagulation of neonates. Which statement by the nursing student requires further teaching? A. The neonate is not born with intestinal flora to synthesize Vitamin K." B. "The Vitamin K injection is not necessary if the mother is breastfeeding." C. "Coagulation factors II, VII, IX, and X are synthesized in the liver." D. "The neonate is given a Vitamin K injection to decrease the risk of bleeding."
B
The nurse assesses that a full-term neonate's temperature is 36.2°C. Thefirst nursing action is to: a. Turn up the heat in the room. b. Place the neonate on the mother's chest with a warm blanket over themother and baby. c. Take the neonate to the nursery and place in a radiant warmer. d. Notify the neonate's primary provider.
B
The nurse encourages the mother to hold her newborn skin-to-skin shortly after birth. What is the most appropriate reason for this action? A. To encourage breastfeeding B. To promote parent-infant attachment C. For infant security until identification bands are applied D. To provide the newborn protective antibodies
B
The nurse is assessing a neonate 1 hour after birth. Which assessment data by the nurse will require further evaluation? A. Apical pulse of105 beats per minute B. Axillary temperature at 97 oF C. Respiratory rate of 32 breaths per minutes D. Hands and feet cyanotic
B
The nurse performs a newborn assessment and finds a heart rate of 180 beats per minute. What data by the nurse is necessary to determine if the heart rate is a sign of distress? A. Skin color B. Time of birth C. Maternal temperature D.Apgar score
B
What statement made by a primiparous patient 4 hours post-delivery requires further assessment by the nurse? A. "Is it normal for it to burn when I go pee?" B."My uterus is cramping really bad. C. "I think I want to try breastfeeding." D. Will you take the baby to the nursery so I can nap?"
B
A G6P5 patient who is 24-hours post vaginal delivery reports severe cramp-like uterine pain. What is the priority nursing intervention for this patient? A. Document the pain score in the electronic medical record. B. Assess the perineum for a vaginal hematoma. C. Encourage warm packs to the abdomen. D. Notify the healthcare provider STAT.
C
A nurse is assessing for the tonic neck reflex. This is elicited by: a. Making a load sound near the neonate. b. Placing the neonate in a sitting position. c. Turning the neonate's head to the side so that the chin is over the shoulderwhile the neonate is in a supine position. d. Holding the neonate in a semi-sitting position and letting the head slightlydrop back.
C
A nurse is caring for a patient who gave birth 30 minutes ago. Upon fundal assessment, the nurse notes moderate vaginal bleeding and a boggy uterus that does not respond to fundal massage. What is the priority nursing action? A. Continue fundal massage. B. Document the findings and reassess in 5 to 10 minutes. C. Increase IV Oxytocin rate. D. Administer misoprostol 600mg rectally.
C
A nurse is checking several newborn reflexes on a 2-day-old neonate. Which reflex would require further investigation? A. The neonate turning the head toward the nurse's finger after stroking the cheek B. The neonate grasping the nurse's fingers tightly when one finger is placed in the palm of the hand C. Asymmetrical abduction of the arms when the nurse jars the crib D. The toes fanning out when the nurse strokes the lateral surface of the sole in an upward motion
C
A postpartum nurse is caring for multiple patients on the mother-baby unit. Which task can the nurse delegate to the Licensed Practical Nurse (LPN)? A. Re-admit a patient 2 weeks post-op cesarean section with an infection B. A G1P1 needing discharge teaching C. A G2P1 who gave birth yesterday and has moderate lochia rubra D. A G6P6 2 days post-op cesarean section at 34 weeks gestation
C
Four babies have just been admitted into the neonatal nursery. Which of thebabies should the nurse assess first? a. The baby with respirations 52, oxygen saturation 98% b. The baby with Apgar 9/9, weight 2960 grams c. The baby with temperature 96.3°F, length 17 inches d. The baby with glucose 60 mg/dL, heart rate 132
C
The nurse is about to elicit the Moro reflex. Which of the followingresponses should the nurse expect to see? a. When the cheek of the baby is touched, the newborn turns toward the sidethat is touched. b. When the lateral aspect of the sole of the baby's foot is stroked, the toesextend and fan outward. c. When the baby is suddenly lowered or startled, the neonate's armsstraighten outward and the knees flex. d. When the newborn is supine and the head is turned to one side, the arm onthat same side extends.
C
The nurse is assessing the neonate's skin and notes the presence of small,irregular, red patches on the cheeks that will develop into single, yellow pimples on the chest or abdomen. The name for this common neonatal skin condition is: a. Milia b. Neonatal acne c. Erythema toxicum d. Pustular melanosis
C
The nurse is caring for a 12-hour-old neonate and incorporating measures to prevent heat loss through conduction. What is the priority nursing action? A. Drying the infant after the first bath B. Placing the infant away from the window C. Warming the stethoscope prior to assessment D. Moving the crib away from the air conditioner vent
C
When assessing the apical pulse of the neonate, the stethoscope should beplaced at the: a. First or second intercostal space b. Second or third intercostal space c. Third or fourth intercostal space d. Fourth or fifth intercostal space
C
Which of the following neonates is at highest risk for cold stress? a. A 36 gestational week LGA neonate b. A 32 gestational week AGA neonate c. A 33 gestational week SGA neonate d. A 38 gestational week AGA neonate
C
A mother refused to allow her son to receive the vitamin K injection at birth. Which of the following signs or symptoms might the nurse observe in the baby as a result? a. Skin color is dusky. b. Vital signs are labile. c. Glucose levels are subnormal. d. Circumcision site oozes blood.
D
A neonate is admitted to the nursery. The nurse makes the following assessments: weight 2845 grams, overriding sagittal suture, closed posterior fontanel, and point of maximum intensity at the xiphoid process. Which of theassessments should be reported to the health-care practitioner? a. Birth weight b. Sagittal suture line c. Closed posterior fontanel d. Point of maximum intensity
D
A perinatal nurse assesses the skin condition of a newborn, which is characterized by a yellow coloration of the skin, sclera, and oral mucous membranes. What condition is most likely the cause of this symptom? a. Hypoglycemia b. Physiologic anemia of infancy c. Low glomerular filtration rate d. Jaundice
D
A pregnant patient at 35 weeks' gestation gives birth to a healthy baby boy. What factors regarding the development of the normal respiratory systemshould the nurse consider when performing an assessment of the neonate? a. As the fetus approaches term, there is an increase in the secretion of intrapulmonary fluid. b. Lung expansion after birth suppresses the release of surfactant. c. Surfactant causes an increased surface tension within the alveoli, whichallows for alveolar reexpansion following each exhalation. d. Under normal circumstances, by the 34th to 36th weeks of gestation,surfactant is produced in sufficient amounts to maintain alveolar stability.
D
During routine assessment, a nurse caring for a postpartum patient notes the uterus is shifted to the side. What is the priority nursing action? A. Notify the physician or midwife. B. Document the findings in the electronic medical record. C. Perform gentle fundal massage. D. Assist the woman to the bathroom.
D
Heat loss through radiation can be reduced by: a. Closing door to room b. Warming equipment used on the neonate c. Drying the neonate d. Placing crib near a warm wall
D
The nurse is assigned four newborns in the nursery. Which newborn should the nurse report to the physician? A. 23-hour-old neonate who has not passed meconium B. Six-hour-old neonate who is large for gestational age with a glucose of 41 C. 2-day-old neonate who has a blood-tinged vaginal discharge D. 2-day-old neonate with irregular respirations at 70 per minute
D
The perinatal nurse explains to a student nurse the cardiopulmonary adaptations that occur in the neonate. Which one of the following statementsaccurately describes the sequence of these changes? a. As air enters the lungs, the PO2 rises in the alveoli, which causes pulmonaryartery relaxation and results in an increase in pulmonary vascular resistance. b. As the pulmonary vascular resistance increases, pulmonary blood flow increases, reaching 100% by the first 24 hours of life. c. Decreased pulmonary blood volume contributes to the conversion from fetalto newborn circulation. d. Once the pulmonary circulation has been functionally established, blood is distributed throughout the lungs.
D
