OB - EXAM 3
You are caring for a woman having surgical birth who is low risk for developing a postpartum venous thromboembolism. The recommended treatment would include: A. Bilateral sequential compression devices and early ambulation B. Low molecular weight heparin 12-24 hours after birth C. Warfarin 24 hours after birth D. Daily low-dose aspirin
A
A nurse in the birth center is working with a patient in her third trimester who has ischemic heart disease. Which of the following should be the primary goal of nursing actions in this situation? A. Prevention of complications B. Reduction of serum cholesterol levels C. Reduction of blood pressure D. Adoption of a heart-healthy diet by the patient
A Antepartum nursing measures should be directed toward prevention of complications related to heart disease, not primary treatment of this condition.
A patient is having a slower-than-normal labor, and the obstetrician is considering a cesarean section. Which of the following should the assisting nurse recognize as risk factors in this patient for dystocia? A. Congenital uterine abnormalities B. Failure to administer analgesia or anesthesia early in labor C. Cephalic face presentation D. Cephalopelvic disproportion E. Maternal fatigue and dehydration
A, C, D, E Congenital uterine abnormalities are a risk factor for dystocia.
A high probability of successful induction is associated with a Bishop score of: A. Greater than 4 B. Greater than 6 C. Less than 4 D. Greater than 6
B
A nurse is assisting a woman in labor who has just learned that her fetus is in persistent occiput posterior position. The primary care provider is recommending cesarean section. The nurse recognizes that this cesarean birth is an example of which type? A. Emergent B. Urgent. C. Nonurgent D. On maternal request
B Urgent cesarean birth indicates a need for rapid delivery of the fetus such as with malpresentation diagnosed after labor has begun (which is the case here) or placenta previa with mild bleeding and with normal Category 1 fetal heart rate.
A woman is recovering from a cesarean birth in a labor and birthing recovery unit. Her partner asks the nurse how long it will take her to recover from the surgery. Which of the following should the nurse say? A. 2 weeks B. 4 weeks C. 6 weeks. D. 8 weeks
C Instruct the family that they need to assist the woman with infant care and housework, as she needs 6 weeks to recover from surgery.
An oxygen saturation below ____ is an abnormal finding for a pregnant woman. A. 90% B. 92% C. 95% D. 97%
D
The most serious complication of the use of intrathecal morphine in the first 24 hours postoperative is: A. Urinary retention B. Nausea and itching C. Decreased sensation in legs D. Respiratory depression
D
Management of women with pre gestational diabetes should begin: A. Before conception B. At the end of the first trimester C. At the end of 20 weeks D. Before the onset of labor
A
The benefits of VBACs include: A. Shorter recovery time, fewer infections, and decreased blood loss B. Decreased pain, decreased fetal stress C. Shorter recovery time, decreased fetal stress D. Decreased discomfort, decreased anxiety
A
The experiences of cesarean birth parents differ from those of vaginal birth parents in which of the following? A. Emotional responses to the childbirth experience B. Ability to breastfeed C. Nutritional needs D. Maternal hormonal changes
A
Women are more receptive to treatment and lifestyle changes during pregnancy, so pregnancy may be a window of opportunity for chemically dependent women to enter treatment. A. True B. False
A
A patient in her first trimester is found to have developed gestational diabetes mellitus (GDM). Which of the following should be the nurse's primary goal for this patient in helping manage this condition? A. Glycemic control B. Lowering blood pressure C. Reducing cholesterol level D. Weight loss
A The cornerstone of management of GDM is glycemic control, or keeping the patient's blood glucose level within normal parameters.
An appropriate gestational age to do glucose screening is: A. 22 weeks of gestation B. 26 weeks of gestation C. 30 weeks of gestation D. 34weeks of gestation
B
A woman with her first pregnancy has been in the second stage of labor for 2 hours with lack of continuing progress. The primary care provider has made three attempts so far to deliver the infant using vacuum extraction. Which of the following interventions should the nurse expect next? A. Continued use of vacuum extraction until the cup pops off the fetal head B. Preparation of the patient for cesarean section C. Administration of oxytocin D. Use of forceps to deliver the baby
B The physician should proceed with a cesarean birth when vacuum attempts are not successful.
A nurse is working with a woman in labor who is obese. What risks at delivery should the nurse be prepared for related to the woman's obesity? A. Small for gestational age neonate B. Fetal microsomia C. Shoulder dystocia D. Down syndrome neonate E. Delayed wound healing
B, C, E
Indication for a cesarean delivery on maternal request is: A. Nonreassuring fetal heart rate B. Placenta previa C. Woman's desire to have a cesarean birth versus vaginal birth D. Obstetrician preference for cesarean delivery
C
Over the past 25 years, the incidence of preterm birth has: A. Declined B. Remained the same C. Increased
C
The goal of magnesium sulfate therapy in treating preeclampsia is to: A. Reduce blood pressure B. Delay delivery C. Prevent seizures D. Increase placental perfusion
C
The nurse would suspect preeclampsia if which of the following was found during assessment? A. Hypertension and diminished reflexes B. Ankle edema and ketonuria C. Proteinuria and hypertension D. Glucosuria and proteinuria
C
Vacuum extractor cup placement on the fetal head should not exceed: A. 5 minutes B. 10 minutes C. 20 minutes D. 30 minutes
C
Which nursing action can improve uterine blood flow, increase umbilical cord circulation, improve maternal oxygenation, and decrease uterine activity? A. Administering oxygen to the mother B. Changing the woman's position C. Discontinuing oxytocin D. Infusing IV fluids
C
You are assigned to take care of a woman, Lisa, who is24 hours postoperative after an emergent cesarean birth related to fetal intolerance of labor. Lisa tells you that she is upset about having a cesarean birth. Your best initial nursing action is to: A. Inform her she has a healthy newborn B. Inform her that most women experience disappointment in having a cesarean birth C. Ask her to tell you more about her feelings D. Explain why she had a cesarean birth
C
A woman who is 1 week past her due date has requested to have labor induced. Which of the following would be a contraindication to induction by oxytocin for this patient? A. Pregnancy-induced hypertension B. Pre-eclampsia C. Abnormal fetal position D. Premature rupture of membranes
C Abnormal fetal position is a contraindication for oxytocin induction, as cesarean section, not vaginal birth, is typically required in such cases.
A nurse is counseling a woman with iron-deficiency anemia regarding when she should take iron supplements to increase absorption and decrease gastrointestinal upset. Which of the following recommendations should she give? A. Take iron supplements in the morning on a full stomach B. Take iron supplements in the morning on an empty stomach C. Take iron supplements at bedtime on an empty stomach D. Take iron supplements at bedtime on a full stomach
C The nurse should advise the patient that taking iron supplementation at bedtime and on an empty stomach may increase absorption and decrease gastrointestinal upset.
Evidence describes the best time for prophylactic antibiotic administration for women having a surgical birth to be: A. After the first postoperative assessment B. After cord clamping C. Within 60 minutes after birth of the infant D. Within 60 minutes prior to incision
D
A nurse is caring for a patient in her third trimester who has gonorrhea. The nurse recognizes that which major complication in the mother is associated with this sexually transmitted infection? A. Hemorrhagic and hypovolemic shock B. Seizures C. Disseminated intravascular coagulation D. Pelvic inflammatory disease
D Sexually transmitted infections, including gonorrhea, can cause pelvic inflammatory disease.
A common indication for an urgent surgical birth includes: A. Fetal intolerance of labor B. Posterior vertex position C. Failed assisted vaginal birth without fetal stress D. Maternal request for the procedure
A
A laboring woman reports spontaneous rupture of membranes and you assess severe decelerations in the FHR. Examination reveals a cord in the vagina. The first nursing action is to: A. Manually elevate the presenting part B. Administer tocolytic agent C. Administer an IV fluid bolus D. Empty the patient's bladder
A
Smoking during pregnancy increases the risk of: A. Low birth weight and prematurity B. Neonatal lung disease C. Preeclampsia
A
When assessing a woman's pain after a surgical birth, the nurse should: A. Recognize pain management is the responsibility of the nurse, the anesthesia provider, and the primary physician B. Ensure that the prescribed pain medications are effective C. Implement non-pharmacologic interventions for promoting maternal comfort before administering pain medications D. Determine whether the pain is visceral or somatic
A
A patient in her first trimester is found on ultrasound to have a hydatiform mole pregnancy. Which of the following would be an appropriate nursing action associated with this condition? A. Offer emotional support related to pregnancy loss B. Administer magnesium sulfate per orders C. Instruct the patient on how to maintain glycemic control D. Prepare the patient for cesarean birth
A A hydatiform mole is a benign proliferating growth of the trophoblast in which the chorionic villi develop into edematous, cystic, vascular transparent vesicles that hang in grape-like clusters without a viable fetus. This is a nonviable pregnancy; thus, an appropriate nursing action in this case would be to offer emotional support related to pregnancy loss.
A primary care provider has approved oxytocin induction in a patient who is 2 weeks post-term. Which of the following doses should the nurse administer to this patient? A. 0.5 mU/min initially and increasing by 1 to 2 mU/min every 30 to 60 minutes B. 1 mU/min initially and increasing by 0.5 to 1 mU/min every 30 to 60 minutes C. 2 mU/min initially and increasing by 2 to 4 mU/min every 30 to 60 minutes D. 4 mU/min initially and decreasing by 0.5 to 1 mU/min every 30 to 60 minutes
A Current dose recommendations are for low-dose oxytocin, starting at 0.5 mU/min and increasing the dose by 1 to 2 mU/min every 30 to 60 minutes until adequate labor progress is achieved.
While performing a vaginal examination of a woman who is in early labor, the nurse observes a pulsating mass protruding from the vagina and notes sudden fetal bradycardia on the fetal heart rate monitor. Which of the following actions should the nurse perform next in this situation? A. Lift the fetal head off of the occluded umbilical cord B. Perform the McRoberts maneuver C. Use forceps to expedite delivery D. Administer oxytocin to augment labor
A Occlusion of the cord due to prolapse may be partially relieved by lifting the presenting part off the cord during a vaginal exam.
On ultrasound during a routine prenatal visit, it is discovered that a patient's placenta is completely covering her internal cervical os. The nurse recognizes that the biggest risk for the patient associated with this condition in the third trimester is which of the following? A. Hemorrhagic and hypovolemic shock B. Eclampsia C. Heart attack D. Aneurysm
A Placenta previa occurs when the placenta attaches to the lower uterine segment of the uterus, near or over the internal cervical os instead of in the body or fundus of the uterus. Hemorrhage is especially likely to occur during the third trimester with development of the lower uterine segment and when uterine contractions dilate the cervix. Thus, if the bleeding is extreme, the woman is at risk for hemorrhagic and hypovolemic shock related to excessive blood loss.
While assisting in the delivery of a baby, the nurse observes the fetal head retract back into the maternal perineum after it had been delivered. The nurse should recognize this as a sign of which of the following obstetrical emergencies? A. Shoulder dystocia B. Prolapse of the umbilical cord C. Ruptured vasa previa D. Rupture of the uterus
A Shoulder dystocia refers to difficulty encountered during delivery of the shoulders after the birth of the head. The first sign is a retraction of the fetal head against the maternal perineum after delivery of the head, sometimes referred to as turtle sign.
A nurse is assisting a patient recovering from cesarean section with breastfeeding her newborn. Which position should the nurse recommend to the patient to prevent pressure on the abdomen during breastfeeding? A. Side-lying. B. Semi-recumbent C. Supine D. Sitting
A The nurse should assist the patient into a comfortable position for infant feeding. Breastfeeding mothers may be more comfortable in a side-lying position, or football hold, which prevents pressure on the abdomen.
A nurse is counseling an obese client who is in her third trimester on a sleeping position that can decrease the negative effects that obesity has on respiratory function. Which of the following should the nurse suggest? A. Sitting position B. Prone position C. Supine position D. Side-lying position
A The nurse should encourage the woman to sleep in a sitting position, as the effects of obesity on the respiratory system are decreased in this position.
A nurse is observing a woman in preterm labor who has been given a tocolytic as well as a corticosteroid. Which of the following should cause the greatest concern in the nurse and be reported to the primary care provider? A. Blood pressure of 145/95 mm Hg B. Heart rate of 110 beats per minute C. Temperature of 99.9°F (37.7°C) D. Elevated white blood cell count (WBC)
A The nurse should report to the provider a blood pressure greater than 140/90 mm Hg.
At an antepartum office visit late in her third term, a patient tells the nurse that several of her friends have had cesarean sections in the past year or two. She asks why cesarean births are typically performed. Which of the following should the nurse mention as primary indications for cesarean birth? A. Previous cesarean birth B. Ineffective uterine contractionS C. Cephalopelvic disproportion D. Breech presentation E. Vertex presentation
A, B, C, D A. Previous cesarean birth is a major indication for repeat cesarean birth, due in large part to the perception of increased risks of a vaginal birth after cesarean, such as for uterine rupture. B. Ineffective uterine contractions that lead to prolonged first stage of labor are an indication for cesarean birth. C. Cephalopelvic disproportion, in which the fetal head does not fit properly through the woman's pelvis, is an indication for cesarean birth. D. Malpresentation or malposition of the fetus, such as breech presentation, transverse lie, or persistent occiput posterior position, is an indication for cesarean birth.
A nurse is assessing a patient's risk factors for preterm labor and birth. Which of the following characteristics of this patient would increase her risk for preterm labor and birth? (SATA) A . Prior preterm birth B. Periodontal disease C. Body mass index (BMI) of 24 D. Age 37 years E. Intimate partner violence
A, B, D, E *Prior preterm birth is the single most important risk factor for preterm labor and birth, with reoccurrence rates of up to 40%. *Infection, especially genitourinary infections and periodontal disease, is a risk factor for preterm labor and birth *Age younger than 17 or older than 35 years is a risk factor for preterm labor and birth. *Preterm birth is more likely in the presence of intimate partner violence.
A nurse is caring for a patient who has just been found on ultrasound to have triplets. Which of the following risks should the nurse expect to be increased in this patient? (SATA) A. Preterm labor and delivery B. Vaginal delivery C. Preeclampsia D. Low birth weight neonate E. Perinatal fetal mortality
A, C, D, E *A woman with multiple gestation is much more likely (90% or higher) to experience preterm labor and delivery than is a woman with a singleton pregnancy. *A woman with multiple gestation is at increased risk for hypertensive disorders and preeclampsia, which tend to develop earlier and be more severe. *A woman with multiple gestation is at increased risk (20%) of delivering a low birth weight neonate. *A woman with multiple gestation is at increased risk of perinatal fetal mortality.
A nurse is assisting in the vaginal birth of a patient who has AIDS. Which of the following actions should be a priority for the nurse in this situation? (SATA) A. Leaving fetal membranes intact B. Using fetal scalp electrodes when possible C. Performing an episiotomy if possible D. Providing and reinforcing education about the disease E. Providing emotional support to the mother
A, D, E *The nurse should leave fetal membranes intact, to prevent bleeding and possible transmission of the disease to the fetus or to medical staff. *The nurse should provide and reinforce education about the disease. *The nurse should provide emotional support to the mother.
An increased risk for shoulder dystocia is associated with: A. Preterm labor B. Maternal diabetes C. VBAC D. Previous precipitous birth
B
Hypoglycemia is defined as a blood glucose below: A. 60 mg/dL B. 70 mg/dL C. 80 mg/dL D. 90 mg/dL
B
In the operating room, the circulating nurse calls a "time-out" before the surgery begins. The purpose of the time-out is to: A. Confirm that the surgeon is ready to begin B. Verify that it is the correct site, procedure, and patient C. Verify that the anesthesia is adequate D. Confirm that the neonatal team is in attendance
B
Preeclampsia, thrombosis, gestational and type II diabetes are associated risk factors for what? A. Good nutrition B. Maternal obesity C. Cardiac problems D. Maternal weight
B
The best intervention to help maintain maternal normothermia in the operating room is to: A. Preheat the radiant warmer and have an insensible fluid loss barrier available B. Provide warm blankets, warmed IV fluids, and maintain the temperature in the operating room between 20-30°C (68-73° F) C. Increase the operating room temperature to 26.7°C (80° F) D. Have the woman wear a heavy cloth gown and slippers to the operating room
B
The likelihood of dizygotic twinning is affected by: A. Advance maternal age B. Use of assisted reproductive technology C. Maternal nutritional status
B
When fetal vessels are unsupported by placenta or the umbilical cord traverses the membranes over the cervix, below the presenting part, this is referred to as: A. Anterior dystocia B. Vasa Previa C. Breech D. Placenta Previa
B
A nurse has just assisted in a vaginal birth that required vacuum extraction. A large cephalohematoma is evident on the neonate's head as a result of this method of delivery. What other condition should the nurse expect to see in this neonate that is associated with cephalohematoma? A. Cyanosis B. Jaundice C. Microsomia D. Lanugo
B A risk for the newborn associated with vacuum-assisted delivery is cephalohematoma and therefore increased risk of jaundice, which is a yellowish discoloration of the skin.
A nurse is observing a patient with severe preeclampsia when the patient begins to have a seizure. The nurse calls for help. Which of the following is the most critical intervention for the nurse to perform next? A. Raise side rails and pad them B. Lower the head of the bed and turn the woman's head to one side C. Record the time, length, and type of seizure activity D. Administer magnesium sulfate per orders
B Because aspiration is the leading cause of maternal mortality, the most critical intervention for the nurse to perform at this time is to lower the head of the bed and turn the woman's head to one side to help ensure a patent airway.
A nurse is caring for a patient who has an acute asthma exacerbation during labor. Which of the following interventions should the nurse make? A. Measure blood pressure B. Administer oxygen C. Assist patient in performing breathing exercises D. Take a detailed history of respiratory status
B During an acute asthma exacerbation in the patient, the nurse should administer oxygen to maintain PaO₂ greater than 95%.
A multiparous patient passes through the latent phase of pregnancy normally, with cervical dilation and effacement progressing and contractions gradually increasing in frequency, duration, and intensity. Once she reaches the active phase, however, the contractions decrease in these three measures, and progress in dilation ceases. The nurse recognizes this dysfunction of labor as which of the following? A. Hypertonic uterine dysfunction B. Hypotonic uterine dysfunction C. Precipitous labor D. Fetal dystocia
B Hypotonic uterine dysfunction occurs when the pressure of the uterine contraction is insufficient to promote cervical dilation and effacement. Typically, the woman makes normal progress during the latent phase of labor, but during active labor the uterine contractions become weaker and less effective for cervical changes and labor progress, which is the case here.
On ultrasound, it is discovered that a patient's trophoblast of the placenta has invaded the uterine wall beyond the normal boundary but not into the uterine myometrium. The nurse should recognize that the patient has which of the following conditions? A. Placenta previa B. Placenta accrete C. Placenta increta D. Placenta percreta
B In placenta accreta, invasion of the trophoblast is beyond the normal boundary (80% of cases).
On examination, a nurse finds that a patient in her third trimester is experiencing hyperventilation and increased tidal volume. An increase in which hormone during pregnancy can account for this phenomenon? A. Estrogen B. Progesterone C. Testosterone D. Adrenaline
B Increased progesterone during pregnancy results in maternal hyperventilation and increased tidal volume.
A woman has been diagnosed with preeclampsia in the 25th week of her pregnancy. Her primary care provider orders magnesium sulfate to be administered to her. The nurse recognizes that which of the following is the proper rationale for this intervention? A. Lower the blood pressure B. Clear up a group B Streptococcus infection C. Reduce the risk of seizures D. Decrease blood glucose level
B Magnesium sulfate, a central nervous system depressant, has been proven to help reduce seizure activity without documentation of long-term adverse effects to the woman and fetus.
A woman in her 35th week of gestation experiences premature rupture of membranes (PROM). Which of the following courses of action should the nurse most expect the primary care provider to take in this situation? A. Induction of labor and treatment for group B streptococcal prophylaxis B. A 48-hour course of intravenous ampicillin and erythromycin followed by 5 days of amoxicillin and erythromycin C. A single course of antenatal corticosteroids D. Patient counseling about risks to fetus
B Patients with PROM between 34 and 36 weeks should be managed as if they were at term, with induction of labor and treatment for group B streptococcal prophylaxis recommended.
While assisting in the delivery of a baby, the nurse observes sudden fetal bradycardia (a prolonged deceleration on the fetal heart monitor). The nurse should recognize this as a sign of which of the following obstetrical emergencies? A. Shoulder dystocia B. Prolapse of the umbilical cord C. Ruptured vasa previa D. Rupture of the uterus
B Prolapse of the umbilical cord is when the cord lies below the presenting part of the fetus, becomes entrapped, and circulation is occluded, resulting in fetal heart rate bradycardia.
A woman in her second trimester is found to have a TORCH infection. Which of the following is included in this category? A. Gonorrhea B. Toxoplasmosis C. Human immunodeficiency virus D. Group B streptococcal virus
B TORCH is an acronym that stands for Toxoplasmosis, Other (hepatitis B), Rubella, Cytomegalovirus, and Herpes simplex virus.
A patient is undergoing a scheduled cesarean birth. It is the third cesarean section she has had. Which of the following should the nurse recognize as the most significant long-term complication of repeat surgical birth? A. Prolapse of umbilical cord B. Placenta accrete. C. Malpresentation of the fetus D. Hypotonic uterine dysfunction
B The most significant long-term complication of repeat surgical birth is placenta accreta, in which the placenta penetrates the myometrium of the uterus in part or completely. In all forms of placenta accreta, the placenta does not separate from the uterine wall after delivery, potentially leading to excessive hemorrhage, disseminated intravascular coagulopathy, organ failure, and, in severe cases, death.
A nurse assisting a woman in labor has just learned that the woman will be undergoing an emergency cesarean section due to prolapse of the umbilical cord. In this situation, the nurse should understand that the patient needs to be completely prepared for surgery within how many minutes? A. 15 B. 30. C. 45 D. 60
B The nurse should facilitate the transition to unscheduled surgical birth in a timely manner. Specifically, response to such obstetrical emergencies should occur within 30 minutes, hence the 30-minute "decision to incision" rule.
After assessing the cervical status of a patient who is being considered for oxytocin induction, the nurse finds that dilation is 1 cm, effacement at 20%, station at -2, consistency of cervix medium, and cervical position medium. The patient has had a prior uterine incision and has already experienced rupture of membranes. Which of the following actions does the nurse expect to perform next? A. Prepare the patient for cesarean section B. Prepare the patient for insertion of a balloon catheter C. Prepare the patient for administration of a dinoprostone insert D. Prepare the patient for amniotomy
B The results of the cervical assessment indicate a Butler score of only 4. A score of less than 6 indicates that cervical ripening should be considered before induction is implemented. Because the woman has had a prior uterine incision, pharmacological cervical ripening methods are contraindicated. Thus, mechanical cervical ripening via a balloon catheter is indicated.
A woman who is at 22 weeks of gestation reports pelvic pressure and increased mucoid vaginal discharge. On examination, her cervix is found to be dilated, and on ultrasound, it appears to be funneling. She is not experiencing any contractions. The primary care provider diagnoses her with incompetent cervix. Which of the following courses of action does the nurse anticipate next in this situation? A. Prophylactic cerclage B. Rescue cerclage C. Administration of oxytocin D. Administration of a tocolytic
B Treatment of incompetent cervix is cerclage, which is a type of purse string suture placed cervically to reinforce a weak cervix. Rescue cerclage is placed after the cervix has dilated with no perceived contractions, up to about 24 weeks of gestation, which is the case here.
A woman has just begun emergency cesarean birth when she complains of ringing in her ears, a metallic taste in her mouth, and a feeling like she is about to pass out. Which of the following complications of cesarean birth should the nurse most suspect in this case? A. Maternal respiratory depression related to anesthesia B. Inadvertent injection of the anesthetic agent into the maternal bloodstream. C. An allergic reaction to the anesthesia D. Trauma to the bowel and subsequent hemorrhage
B When the anesthetic agent is inadvertently injected into the maternal bloodstream, the woman experiences ringing in her ears, a metallic taste in her mouth, and hypotension that can lead to unconsciousness and cardiac arrest.
A woman is recovering from cesarean section in the labor and birthing recovery unit. During surgery, the woman received intrathecal morphine for postoperative pain management. Which of the following complications related to morphine should the nurse expect to find in this patient? A. Hypertension B. Pruritus C. Nausea and vomiting D. Lower back pain E. Urinary retention
B, C, E The primary side effects of intrathecal morphine are pruritus (itching), nausea and vomiting, urinary retention, and respiratory depression.
A woman in her first trimester reports to the office with abdominal pain and vaginal bleeding. On ultrasound, it is found that the blastocyst has implanted in the fallopian tube. The nurse recognizes this condition as which of the following? A. Placenta accreta B. Eclampsia C. Ectopic pregnancy D. Hyperemesis gravidarum
C An ectopic pregnancy develops as a result of the blastocyst implanting somewhere other than the endometrial lining of the uterus. The embryo or fetus in an ectopic pregnancy is absent or stunted, and this is a nonviable pregnancy. The vast majority of ectopic pregnancies occur in the fallopian tube (95%).
A patient in her third trimester has just been diagnosed with moderate (grade 2) placental abruption. Which of the following signs and symptoms should the nurse expect to find in this patient? A. No blood loss, normal vital signs and fetal heart rate pattern B. Blood loss less than 500 mL, vague lower abdominal discomfort, normal vital signs and fetal heart rate C. Blood loss 1,000 to 1,500 mL, abdominal pain, mild shock, fetal heart rate shows signs of compromise D. Blood loss greater than 1,500 mL, abrupt and knifelike uterine pain, moderate-to-profound shock, fetal heart rate shows signs of compromise
C Blood loss 1,000 to 1,500 mL, abdominal pain, mild shock, and fetal heart rate showing signs of compromise indicate moderate (grade 2) placental abruption.
A nurse is describing to a patient how in pregnancy there are increased levels of coagulation factors and decreased fibrinolysis, venous dilation, and obstruction of the venous system by the gravid uterus. Which common complication associated with these changes should the nurse mention? A. Gestational diabetes mellitus B. Infertility C. Deep vein thrombosis D. Pelvic inflammatory disease
C Deep vein thrombosis is a complication associated with the changes described.
A woman who is in her first trimester of pregnancy has been admitted to the hospital with severe vomiting. She is dehydrated and her electrolytes are out of balance. The nurse recognizes this condition as which of the following? A. Preeclampsia B. Eclampsia C. Hyperemesis gravidarum D. Placenta previa
C Hyperemesis gravidarum is vomiting during pregnancy that is so severe it leads to dehydration, electrolyte and acid-base imbalance, starvation ketosis, and weight loss.
A woman's primary care provider has just applied dinoprostone gel to her cervix to ripen it. The woman would like to know how long she must wait until oxytocin can be administered. Which of the following should the nurse tell the patient? A. 1 hour after dose B. 2 to 4 hours after dose C. 6 to 12 hours after dose D. 24 hours after dose
C Oxytocin should be delayed for 6 to 12 hours after a dose of dinoprostone gel has been administered for cervical ripening.
A woman is rushed to the hospital in labor. She says labor began about an hour ago and has progressed rapidly. She is already dilated to 8 cm, and her contractions occur every 2 minutes and last about 70 seconds. The nurse recognizes this dysfunction of labor as which of the following? A. Hypertonic uterine dysfunction B. Hypotonic uterine dysfunction C. Precipitous labor D. Fetal dystocia
C Precipitous labor is a labor that lasts fewer than 3 hours from onset of labor to birth. This type of labor is characterized by hypertonic uterine contractions that occur every 2 minutes or more and last more than 60 seconds. Unlike in hypertonic uterine dysfunction, however, the hypertonic contractions in precipitous labor result in rapid cervical dilation.
A nurse is preparing a patient for a scheduled cesarean birth. Shortly before the procedure, the nurse administers an anticoagulant to the patient, per the primary care provider's instructions. Which of the following is the appropriate rationale for this intervention? A. To reduce the risk of bacterial infection in all women B. To decrease blood pressure in women who are hypertensive C. To reduce the risk of venous thromboembolism in women who are prone to thrombosis. D. To decrease blood glucose level in women who are diabetic
C Preoperative anticoagulant therapy may be necessary for women classified as moderate or high risk or with a history of recurrent thrombosis.
A patient in her 36th week of gestation has just learned that her fetus has died. The nurse explains that the labor will need to be induced within 24 to 48 hours and the fetus delivered. The patient is devastated. She explains that her husband is out of the country and asks whether induction can be postponed a few days more until he returns. Which of the following should the nurse mention as a risk of prolonged retention of the dead fetus? A. Rupture of the uterus B. Prolapse of the umbilical cord C. Disseminated intravascular coagulation D. Eclampsia
C Prolonged retention of the dead fetus may lead to the development of disseminated intravascular coagulation in the mother and puts the mother at higher risk for infection, which can result in sepsis or endometritis.
A nurse is assisting a woman in the second stage of labor who is experiencing inadequate expulsive forces. Which of the following actions would be most appropriate for the nurse to take in this case? A. Explain to the woman that it would be safest to deliver the baby within 2 hours after entering the second stage of labor B. Encourage the woman to use the Valsalva maneuver when bearing down C. Coach the woman to keep an open glottis when bearing down D. Help the woman into a supine position to facilitate fetal descent
C The nurse should encourage the woman to minimize the Valsalva maneuver by using open glottis push strategies.
A patient has gone into preterm labor at week 33 of gestation. The attending physician has ordered that the patient be given the calcium channel blocker nifedipine, a common tocolytic drug. The nurse should recognize that which of the following is the appropriate rationale for this intervention? A. To stop preterm labor and ensure a full-term delivery B. To facilitate fetal lung maturity C. To delay delivery for up to 72 hours D. To clear up group B Streptococcus infections
C Tocolytic drugs, of which the calcium channel blocker nifedipine is one, are medications that are used to suppress uterine contractions in preterm labor and thus to delay delivery for up to 72 hours so that glucocorticoids (corticosteroids) can be administered and facilitate fetal lung maturity.
A nurse sees a patient who is in the second trimester of pregnancy smoking outside the doctor's office just before her antepartal appointment. Which of the following should the nurse do when meeting with the patient later in the office? A. Adopt an adversarial approach if the woman does not agree to seek treatment B. Assume that the patient will not quit and proceed with the examination C. Provide nonjudgmental health education about the risks to the fetus of substance use during pregnancy D. Let the physician know that the woman is a smoker so that the physician can discuss it during the exam
C Women are more receptive to treatment and lifestyle changes during pregnancy; therefore, pregnancy may be a window of opportunity for chemically dependent women to enter treatment. To facilitate this, nurses must be armed with knowledge and information necessary to screen and identify women who abuse substances during pregnancy. The nurse should maintain a nonjudgmental and nonpunitive attitude.
A nurse is observing a patient with severe preeclampsia when she receives the patient's latest laboratory values. Which of the following changes indicated by the laboratory results are indicative of a life-threatening condition that occurs as a complication of severe preeclampsia? (SATA) A. Increased blood glucose B. Elevated triglycerides C. Hemolysis D. Elevated liver enzymes E. Low platelets
C, D, E *HELLP syndrome is the acronym used to designate the variant changes in laboratory values that can occur as a complication of severe preeclampsia.
The first sign of shoulder dystocia is referred to as: A. Unsuccessful vaginal delivery B. Breech C. Bishop Score D. Turtle sign
D
Type 1 diabetes is associated with: A. Decreased pancreatic function B. Insulin resistance C. Inappropriate response to insulin D. Absolute insulin deficiency
D
Which of the following is an indication to turn off magnesium sulfate in a woman managed with preeclampsia? A. Blood pressure 190/110 mm Hg B. Nausea and vomiting C. Epigastric pain D. Respiratory rate of 13 breaths/min
D
Women 40 years or older have a cesarean rate of: A. 25.5% B. 62.5% C. 35.5% D. 49.5%
D
A woman who has had a previous birth via cesarean section is now being considered for a vaginal birth after a cesarean (VBAC). Which of the following should the nurse recognize as a contraindication to VBAC in this woman? A. A prior low transverse cesarean birth B. A clinically adequate pelvis C. Age 38 years D. Prior vertical uterine incision
D Prior vertical (classical) or T-shaped uterine incision or other uterine surgery is a contraindication for VBAC.
Soon after learning that she was pregnant, a patient calls the office reporting heavy vaginal bleeding. On examination in the office, it is discovered that the patient has lost her pregnancy. The nurse should record this event as which of the following in the patient's record? A. Induced abortion B. Elective abortion C. Therapeutic abortion D. Spontaneous abortion
D Spontaneous abortion is termination of a pregnancy before 20 weeks' gestation without medical or mechanical means. It is also called miscarriage.
A nurse is assisting a couple who has just learned that the laboring woman will be undergoing emergency cesarean birth. What should the nurse instruct the patient's partner to do while the woman is undergoing surgery? A. Go to the waiting room and remain there until the operation is over B. Watch the procedure, if desired, through a window in an adjacent room C. Stand at the foot of the operating room table and observe the procedure D. Remain on a stool next to the woman's head and offer support.
D The nurse should position the expectant father or support person on a stool next to the woman's head and instruct this person to remain seated there during the procedure, offering support to the woman.
