OB Exam 1

What is the average/normal response for DTRs?

2+

An insulin-dependent diabetic woman will require higher doses of insulin as which of the following pregnancy hormones increases in her body? 1. Estrogen. 2. Progesterone. 3. Human chorionic gonadotropin. 4. Human placental lactogen.

4. Human placental lactogen

What is a successful LATCH score

8-10

After teaching a woman who has had an evacuation for gestational trophoblastic disease (Hydratiform mole/molar pregnancy) about her condition, which statement indicates that the teaching was effective? A. "I will be sure to avoid getting pregnant for at least 1 yr." B. "My intake of iron will have to be closely monitored for 6 months." C. "My BP will continue to be increased for about 6 more months." D. "I won't use my birth control pills for at least a year or two."

A. "I will be sure to avoid getting pregnant for at least 1 yr."

An RN determines that a gestational diabetic patient in preterm labor has a reactive NST when which findings are noted? A. 2 FHR accelerations of 15 bpm above baseline for at least 15 sec in a 20 min period B. A FHR acceleration of 15 bpm above baseline for at least 15 sec in a 20 min period C. 2 FHR accelerations of 20 bpm above baseline for at least 20 sec in a 20 min period D. The absence of decelerations in a 20 min period.

A. 2 FHR acceleration of 15 bpm above baseline for at least 15 sec in a 20 min period

A pregnant woman with gestational diabetes comes to the clinic for a fasting blood glucose level. When reviewing the results, the Rn determines that which result indicates good glucose control? A. 88 B. 100 C. 110 D. 120

A. 88

A patient 32 weeks pregnant with severe headache is admitted with preeclampsia. In addition to baseline vital signs and placing them on bedrest, the physician ordered the following. Which of the orders should the RN perform first? A. Assess DTRs B. Obtain CBC C. Assess baseline weight D. Obtain routine UA

A. Assess DTRs

A pregnant woman at 10 weeks exhibits the following signs of pregnancy. Which one is categorized as a probable sign of pregnancy? A. Chadwick's sign B. Breast tenderness C. Morning sickness D. Fetal heart sounds

A. Chadwick's sign

The client has been having contractions every 5 min for 7 hrs. Which factor would the nurse use to determine if this is true labor? A. The cervix is showing a pattern of effacement and dilation B. The client has given birth to 3 children previously C. The contractions increase in intensity and duration D. There was a SROM

A. Changes in the cervix, showing a pattern of effacement and dilation.

A 10-week pregnant woman with diabetes has a glycosylated hemoglobin (HbA1c) level of 13%. At this time the nurse should be most concerned about which of the following possible fetal outcomes? A) Congenital anomalies B) Incompetent cervix C) Placenta previa D) Abruptio placentae

A. Congenital anomalies

A pregnant diabetic has been diagnosed with hydramnios. Which of the following would explain this finding? A. Excessive fetal urination B. Recurring hypoglycemic episodes C. Fetal sacral agenesis D. Placental vascular damage

A. Excessive fetal urination

A client who is 14 weeks pregnant mentions that she has been having difficulty moving her bowels since she became pregnant. Which hormones are responsible for this common discomfort during pregnancy? A. progesterone B. estrogen C. testosterone D. human chorionic gonadotropin

A. Progesterone

A laboring patient is experiencing dyspnea, diaphoresis, tachycardia, and hypotension. The RN suspects aortocaval compression. What intervention should the RN implement immediately A. Turning the patient on her left side B. Turning the patient on her right side C. Positioning the bed in reverse Trendelenburg's position D. Positioning the patient in a supine position

A. Turning the patient on her left side

A pregnant patient is scheduled for chorionic villus sampling. The nurse is describing the procedure and the protentional complications. Then providing care to the patient after the testing, the nurse would be alert for which complication as the MOST common (select all that apply) A. Vaginal Spotting B. Cramping C. spontaneous abortion D. rupture of membranes E. Hematoma

A. Vaginal Spotting B. Cramping

A patient at 28 weeks gestation who has been diagnosed with severe preeclampsia is noted to have a BP 170/112, 4+ proteinuria, and a weight gain of 10 lbs over the past 2 days. Which instruction(s) from the HCP would the RN question? SATA A. Weight the patient weekly B. Have the patient eat a low-protein diet C. Order labetalol 200 mg twice a day D. Administer magnesium sulfate 2 g/hr E. Maintain bedrest

A. Weight the patient weekly B. Have the patient eat a low-protein diet

A nurse is assessing a pregnant woman on a routine checkup. When assessing the woman's gastrointestinal tract, what would the nurse expect to find? SATA A. hyperemic gums B. increased peristalsis C. complaints of bloating D. heartburn E. nausea

A. hyperemic gums C. Complaints of bloating D. Heartburn E. Nausea

These are transient increases in the fetal heart rate about 15 bpm above the baseline that are about 15 sec apart.

Accelerations

What is the first action taken after birth to ensure safety?

Applying ID bands/sensors.

Where is the MMR vaccine given, and what size needle is used?

Arm, 25G 5/8" (SQ)

A nurse is teaching a pregnant woman about recommended weight gain. The woman has a pre-pregnancy BMI of 21. The nurse determines that the teaching was successful when the woman states she should gain no more than which amount during pregnancy A. 35 to 40 pounds B. 25 to 35 pounds C. 28 to 40 pounds D. 15 to 25 pound

B. 25-35 pounds

A pregnant woman is admitted with PROM. The RN is assessing the woman closely for possible infection. Which finding would lead the RN to suspect that the woman is developing an infection? SATA A. Fetal bradycardia B. Abdominal tenderness C. Elevated maternal pulse D. Decreased C-reactive protein level E. Cloudy malodorous fluid

B. Abdominal tenderness C. Elevated maternal pulse D. Cloudy malodorous fluid

A patient is Group Beta Strep Positive (GBS) at the beginning of labor The nurse should prepare this woman for: A. cesarean birth B. IV administration of penicillin during labor C. Isolation of her newborn after birth D. Application of acyclovir to her labial lesions.

B. IV administration of penicillin during labor

The RN is admitting a full-term pregnant patient presenting with bright red vaginal bleeding, intense abdominal pain, a blood pressure of 150/96, and pulse of 109. Which problem should the RN suspect that the patient is likely experiencing? A. Placenta previa B. Placental abruption C. Bloody show D. Succenturiate placenta

B. Placental abruption.

The RN is developing a POC for a women who is pregnant with twins. The RN includes interventions focusing on which area because of the woman's increased risk? A. Oligohydramnios B. Preeclampsia C. Post-term labor D. Chorioamnionitis

B. Preeclampsia

A primigravida patient has been pushing for 2 hrs. When the head emerges the fetus fails to deliver. The physician notes that the turtle sign has occurred. Which should be a RN's interpretation of this? A. Cephalopelvic disproportion B. Shoulder dystocia C. Persistent occiput posterior position D. Cord prolapse

B. Shoulder dystocia

Chadwick's sign

Bluish-purple coloration of the vaginal mucosa and cervix

What does BUBBLE-EE stand for?

Breasts Uterus Bladder Bowels Lochia Episiotomy/Laceration Extremities Emotional status

A G1P0 client's cervix is 4 cm dilated. She tells the nurse, "I'm in pain, but I'm afraid that medication might harm my baby." Which response by the nurse is the most therapeutic regarding pain medication during labor? A. "Pain medications do affect the baby, but so do pain and stress." B. "You are correct in your belief that medication might harm your baby." C. "The doctor has ordered only a small amount, so your baby will be quite safe." D. "The new medications are so much safer than the old medications."

C. "The doctor has ordered only a small amount, so your baby will be quite safe."

A 14 year old woman is seeking obstetric care. Which of the following vital signs must be monitored carefully during her pregnancy? A. HR B. RR C. BP D. Temp

C. BP

A patients maternal serum alpha-fetoprotein was unusually elevated at 17 weeks. The nurse suspects which condition? A. Fetal hypoxia B. open spinal defects C. Down Syndrome D. maternal hypertension

C. Down Syndrome

An RN is conducting an inservice program for a group of RNs working at the women's health facility about the causes of spontaneous abortion. The RN determines that the teaching is successful when the groups identifies which condition as the most common cause of first trimester abortions? A. Maternal disease B. Cervical insufficiency C. Fetal genetic abnormalities D. Uterine fibroids

C. Fetal genetic abnormalities

A woman has entered the ED subsequent to a head-on MVA. Her body appears uninjured. The RN carefully monitors her for which following complication? SATA A. Placenta previa B. Transverse fetal lie C. Placental abruption D. Severe preeclampsia E. Preterm labor

C. Placental abruption E. Preterm labor

Which of the following RN observations would indicate a sign of impending placental separation and expulsion after the delivery of the baby? A. Steady trickle of blood with an unchanged cord length B. Lengthening of the cord with associated cord tear C. Small gush of blood with lengthening of the cord D. Small gush of blood with an unchanged cord length

C. Small gush of blood with lengthening of the cord

An RN is caring for a woman who is being evaluated for a suspected malpresentation. The fetus's long axis is lying across the maternal abdomen, the contour of the abdomen in enlarged. Which should the RN's document of the lie of the fetus? A. Vertex B. Breech C. Transverse D. Brow

C. Transverse

A nurse is caring for a client with DM1 who is 39 weeks pregnant. Which of the following will the nurse include in the client's plan of care? SELECT ALL THAT APPLY. A. including a bedtime snack with protein B. administering glyburide 5 mg every morning C. performing twice-weekly fetal nonstress tests D. obtaining a fetal biophysical profile E. monitoring blood sugar 3 times a day

C. performing twice-weekly fetal NST D. obtaining a fetal biophysical profile E. monitoring blood sugar 3 times a day

What does 3-4 beats of clonus represent.

CNS overstimulation, impending seizure.

This is caused by birth trauma between the skull and periosteum and increases the risk for jaundice.

Cephalhematoma

What must the nurse do before giving a mother her baby?

Check the ID band

Pigmentation changes in pregnancy

Chloasma (mask of pregnancy), linea nigra, darkening of areola

A pregnant woman with four children reports the following obstetrical history: a stillbirth at 32 weeks, triplets born via cesarean section at 30 weeks, a spontaneous abortion at 8 weeks, and a daughter born vaginally at 39 weeks. Which of the following is the correct expression of her obstetrical history? A. 5: 1-4-1-4 B. 4: 1-3-1-4 C. 5: 2-2-0-3 D. 5: 1-2-1-4

D. 5: 1-2-1-4

A nurse is reviewing the results of four patients who have undergone amniocentesis. Which patient would the nurse recommend that the HCP see first? A. A patient 16 weeks with a placenta previa and a high alpha-protein level B. A patient 34 weeks gestation with gestational diabetes and L/S ratio of 2:1 C. A patient 36 weeks gestation with preeclampsia and amniotic fluid negative for bilirubin D. A patient 38 weeks gestation with a fetal heart rate of 108 and green amniotic fluid sample

D. A patient 38 weeks gestation with a fetal heart rate of 108 and green amniotic fluid sample

Which of the following would be the highest priority of the RN who is caring for the laboring patient? A. Pain relief measures that are offered are acceptable to the patient B. Involvement of the patient's partner with the labor and delivery C. Monitoring of appropriate fluid intake D. Assessment of fetal response to the labor

D. Assessment of fetal response to the labor

It is determined that a patient's blood Rh is negative and her partner's is positive. To help prevent isoimmunization, the RN would expect to administer Rho(D) immune globulin at which time? A. At 32 weeks gestation and immediately before discharge B. 24 hrs before delivery and 24 hrs after delivery C. In the first trimester and within 2 hrs of delivery D. At 18 weeks gestation and again within 72 hrs after delivery

D. At 28 weeks gestation and again within 72 hrs after delivery

A 25 yo patient is admitted with the following history: 12 weeks pregnant, vaginal bleeding, no fetal heartbeat seen on ultrasound. The RN would expect the physician to order to prepare her for which of the following? A. Cervical cerclage B. Amniocentesis C. NST D. Dilatation and curettage (D&C)

D. D&C

An RN suspects the patient is developing HELLP syndrome. They notify the HCP based on which finding? A. Hyperglycemia B. Elevated platelet count C. Disseminated Intravascular Coagulopathy (DIC) D. Elevated liver enzymes

D. Elevated liver enzymes

A client has severe preeclampsia. The RN would expect the primary HCP to order tests to assess the fetus for which of the following A. Severe anemia B. Hypoprothrombinemia C. Craniosynostosis D. IUGR

D. IUGR

An RN's patient who is in labor is waiting for lab results to come back so epidural anesthesia can be administered. Which result is abnormal and should be reported to the physician? A. WBC 24,000 B. Glucose 78 C. Hgb 13.2 D. Platelets 112,000

D. Platelets 112,000.

The nurse is administering intravenous magnesium sulfate as prescribed for a client at 34 weeks' gestation with severe preeclampsia. What are desired outcomes of this therapy? SELECT ALL THAT APPLY. A. temperature, 98° F (36.7° C); pulse, 72 beats/min; respiratory rate, 14 breaths/min B. urinary output less than 30 mL/h C. fetal heart rate with late decelerations D. deep tendon reflexes 2+ E. magnesium level = 5.6 mg/dL (2.8 mmol/L)

D. deep tendon reflexes 2+ E. magnesium level = 5.6 mg/dL (2.8 mmol/L)

A pregnant patient in the third trimester has a hemoglobin of 11g/dL. The nurse interprets this as indicating: A. iron-deficiency anemia B. a multiple gestation pregnancy C. greater than expected weight gain D. hemodilution of pregnancy

D. hemodilution of pregnancy

What could "rust stains" on a newborn's diaper indicate?

Dehydration

Benign spots on the gums

Epstein's Pearls

What could be the cause of the fundus being slightly deviated to the right?

Full bladder

What are you assessing during a fundal assessment?

Fundus location, tone, and lochia

What are the steps to fundal assessment?

Head of bed flat, non-dominant hand beneath to support, dominant hand measuring/massaging.

Weights for LGA and SGA.

LGA = >4,000g SGA = <2500g

Naegle's Rule

LMP - 3 months + 7 days

These are caused by utero-placental insufficiency

Late decelerations

What vaccine is given for measles, mumps, and rubella?

MMR

What is the priority action if a patient is bleeding postpartum?

Massage the fundus

Why and where is vitamin K given to newborns? Using what needle?

Prevent bleeding and hemorrhage. Vastus lateralis. 25G 5/8"

Why is erythromycin ophthalmic ointment used on newborns?

Prevent eye infections r/t gonorrhea or chlamydia

What are presumptive signs of pregnancy?

Subjective signs perceived by the woman Ex: amenorrhea, breast changes/tenderness, nausea/vomiting, urinary frequency, weight gain, fatigue, quickening

What are the normal vital signs for a newborn?

Temp: 36.5-37 *C HR: 110-160 RR: 30-60

What is the most important vital sign to take before a newborn's first bath?

Temperature

When is the MMR vaccine administered to an unvaccinated mother?

The immediate postpartum peiod.

Positive signs of pregnancy

Ultrasound verification. Provider palpated fetal movement. Fetal heart tones via Doppler

What are beat to beat changes in a fetal heart rate called?

Variability