ob exam 3
1. A 28-year-old woman is a primipara who is pregnant with triplets, is at 18 weeks' gestation, and is receiving regular prenatal care. The nurse identifies a risk for preterm labor related to which factor? 1) The patient's age 2) 18 weeks' gestation 3) Multiple gestations 4) Previous obstetric history
3
10. A laboring patient's water breaks, and the umbilical cord protrudes from the vagina. The nurse immediately places the patient in the Trendelenburg position. Which of the seven Ps is most impacted? 1) Passage 2) Pain 3) Powers 4) Position
3
12. Which medication is contraindicated immediately prior to performance of a cesarean section? 1) Cefazolin 1 g IV 2) Famotidine 20 mg IV |3) Fentanyl 100 mcg IV |4) Citric acid-sodium citrate solution 30 mL PO
3
12. Which of the following is a factor associated with macrosomia? 1) Female fetus 2) Maternal weight loss 3) Gestational diabetes 4) Caucasian ethnicity of the mother
3
2. A nurse is assessing a patient who has undergone an amniotomy. Which assessment finding is most important for the nurse to report immediately? (1) Promotion of labor 2) Clear, odorless amniotic fluid 3) Abnormal fetal heart rate (FHR) pattern 4) Wet underpads from vaginal leakage of clear fluid
3
3. A nurse is preparing a patient for an external cephalic version. The nurse notices that the patient is Rh-negative and has received limited prenatal care. The nurse expects to see which medication ordered by the health-care provider? 1) Oxytocin 2) Magnesium sulfate 3) RhoGAM 4) IV Antibiotics
3
3. Which of the following is a sign of magnesium sulfate toxicity? 1) Blood pressure of 140/80 2) GI upset 3) Respiratory rate of 12 4) Hyperactive deep tendon reflexes
3
5. The nurse is caring for a patient at 37 weeks' gestation who experienced premature rupture of membranes (PROM). Which assessment finding would indicate possible chorioamnionitis? 1) Temperature of 37°C 2) Presence of amniotic fluid 3) Elevated heart rate 4) Hypertension
3
7. A patient is approaching 42 weeks' gestation and has been admitted for induction of labor. The patient tells the nurse that she does not want an induction and prefers to wait for labor to begin naturally. Which is the nurse's best response? 1) "Waiting for labor to begin naturally could result in the death of your baby." 2) "The longer you wait, the bigger the baby gets and the harder delivery will be." 3) "Complications for you and your baby increase after 42 weeks of gestation." 4) "If you had controlled your weight gain during pregnancy, you might have gone | into natural labor."
3
8. The nurse is providing teaching to a patient with oligohydramnios. What should the nurse include in the teaching session? 1) "You will need to begin taking indomethacin." 2) "You will need to have the excess amniotic fluid drained." 3) "You should drink at least 2 liters of water per day." 4) "You are at risk of preterm labor because of the increased uterine size."
3
9. Which patient does the nurse identify as likely to require a cesarean delivery? 1) Post-term 2) Vertex presentation |3) Multiple gestations 4) Treated genital herpes 4 years prior to pregnancy
3
A laboring patient is delivering an infant with shoulder dystocia. Which of the following is an appropriate intervention? (1) Massage the fundus. 2) Place the patient in left side-lying position. 3) Assist the provider with the McRoberts maneuver. 4) Administer a tocolytic.
3
A patient who is 6 weeks postpartum asks the nurse when she will start her menstrual cycle. How should the nurse respond? 1) "You should start your cycle in 2 weeks." 2) "How much sleep are you getting?" 3) |"Are you breastfeeding?" 4) "You should begin your period the month after delivery
3
An hour after delivery the postpartum patient begins to have a seizure and labored breathing. The nurse suspects this life-threatening complication may be caused by what? 1) Retained placenta 2) Uterine inversion 3) Fetal debris 4) Precipitous labor
3
The nurse admits a woman in labor after a motor vehicle accident that also involved her 14-month old child. Fetal monitoring shows a nonreassuring fetal heart rate pattern with variable and late decelerations. Maternal examination reveals uterine tenderness and constant abdominal pain. After notifying the provider, which is the nurse's priority of care? 1) Encouraging the patient to begin pushing 2) Obtaining a precipitous delivery pack 3) Initiating an IV with an 18-gauge catheter 4) Cleansing the perineum
3
The nurse is assessing a postpartum patient within the first hour after delivery and notes that her peripad is saturated. Which is the nurse's priority action? 1) Call the provider immediately. 2) Obtain consent for blood transfusion. 3) Change the peripad and document findings. 4) Put the patient in the Trendelenberg position.
3
The nurse is assessing a postpartum patient's peripad 6 hours after delivery. How should the nurse document lochia that is 5 inches in diameter? 1) Scant 2) Light 3) Moderate 4) Heavy
3
The nurse is making a home-care visit when the newborn starts to cry. The new mother smiles and says, "That's his hungry cry." The nurse interprets this as indicating the mother is in which phase of maternal role attainment? 1) Taking-in phase 2) Taking-hold phase 3) Letting-go phase 4) Transitioning from taking-in to taking-hold phase
3
While reviewing laboratory values, the nurse sees a postpartum patient's white blood cell count is 26,699 mg/dL, and her neutrophil count is also elevated. Which is the nurse's priority action? (1) (Assessing the episiotomy for signs of infection 2) Notifying the RN and/or provider 3) Continuing to monitor laboratory findings 4) Obtaining STAT vital signs
3
14. A patient is at her routine visit 2 weeks prior to her scheduled cesarean delivery. Which teaching should the nurse provide in order to prepare the patient for hospital admission? (1) Pack for 3 to 5 days in the hospital. 2) Arrange for help at home. 3) Sign a consent for the epidural. 4) Maintain good hydration.
1
15. The nurse assesses which patient has the best chance of a successful vaginal birth after a cesarean section? 1) The woman whose first and third children were born vaginally 2) The woman with well-controlled gestational diabetes 3) The woman whose last child is 12 months old and was born by cesarean section 4) The woman requiring induction of labor 4 years after a cesarean section
1
4. After a successful external cephalic version, the patient says, "Oh good! Now I won't have to worry about having a cesarean section!" Which teaching should the nurse provide this patient in response to this comment? 1) The fetus can drift back into an abnormal presentation. 2) There is no reason to worry about having a cesarean section. 3) Potential complications may follow the procedure. 4) Need to drink plenty of fluids for the next 24 hours.
1
6. A nurse is discussing the methods of cervical ripening and induction of labor with the patient. Which method does the nurse inform as the safest and least likely to result in complications? 1) Insertion of a transcervical Foley catheter 2) Application of prostaglandin gel 3) Administration of Prepidil Endocervical Gel 4) Infusion of oxytocin (Pitocin)
1
9. A laboring patient woman with a history of sexual abuse is experiencing anxiety and flashbacks of previous abuse. Which of the seven Ps is impacting her labor? 1) Psyche 2) Pain 3) Powers 4) Position
1
It is time for a newborn to have blood collected for the newborn screening. How does the nurse turn this into a bonding opportunity for the mother? 1) Perform the test in the mother's room and encourage her to comfort the newborn afterward. 2) Take the baby to the nursery for the test to avoid upsetting the mother. 3) Explain the bandage on the baby's foot when returning the baby to the mother's room. 4) Perform the test without mentioning it to the mother to reduce anxiety.
1
The nurse is assessing a postpartum woman's understanding of sitz baths. Which statement made by the patient indicates the need for further teaching? 1) "I should add soap to warm water to prepare the sitz bath at home." 2) |"Sitz baths will provide pain relief for my episiotomy." 3) "I can prepare a sitz bath in the tub or in a basin." 4)"I can sit on a soft wet towel in the warm sitz bath water for 10 to 15 minutes three times a day."
1
The nurse is preparing a postpartum patient for discharge. The nurse educates the patient to call the provider if she experiences which symptom? 1) Lochia rubra after transition to serosa or alba 2) Breast tenderness 3) Difficulty sleeping 4) Vaginal soreness
1
Which action by a postpartum mother is a sign of bonding between her and her infant? 1) Positioning the baby facing her so she can explore the baby's face 2) Spontaneously erupting in tears for unexplained reasons 3) Correctly positioning the baby for breastfeeding 4) Asking the nurse to keep the baby in the nursery
1
Which events after delivery of the placenta cause the uterus to contract and begin shrinking to nonpregnant size? 1) Reduced estrogen and progesterone levels 2) Reduced estrogen and oxytocin levels 3) |Reduced progesterone and oxytocin levels 4) Estrogen, progesterone, and oxytocin levels decline.
1
22. A patient has discussed the option of a vaginal birth after a cesarean (VBAC) with her health provider. The nurse understands that the woman has a chance of a successful VBAC delivery based on which of the following history? (Select all that apply.) 1) Prior VBAC 2) Cephalic presentation of the fetus 3) Had a prior vaginal delivery 14) Multiple gestations 5) Gestational age greater than 41 weeks
1, 2, 3
23. A nurse is caring for a patient undergoing a vaginal birth after a cesarean (VBAC). The nurse notifies the health-care provider after observing which signs of uterine rupture? (Select all that apply.) 1) Vaginal bleeding 2) Acute abdominal pain 3) Palpation of fetal parts outside of the uterus 4) Prolonged FHR deceleration 5) Uterine contractions
1, 2, 3, 4
Which of the following types of breech positions is correctly matched with its description? (Select all that apply.) 1) Complete breech: the hips are flexed and the knees are flexed. 2) Frank breech: the hips are flexed and the knees are extended. 3) Footling breech: one or both hips are extended and the foot presents. 4) Incomplete breech: one or both hips are extended and the foot presents. 5) Complete breech: the hips are extended and the knees are extended.
1, 2, 3, 4
20. an immediate cesarean section will need to be performed if the nurse assesses which signs or symptoms in a woman attempting vaginal birth after a prior cesarean section? (Select all that apply.) 1) A popping sensation reported by the patient 2) Acute, continuous abdominal pain 3) Repetitive or prolonged fetal heart rate decelerations 4) Slow labor progression 5) Vaginal bleeding
1, 2, 3, 5
A new mother asks the nurse what she can do to foster attachment between the newborn and her 8 year-old daughter. Which recommendations should the nurse make? (Select all that apply.) 1) Have the child visit in the hospital. 2) Let the child help care for the baby as he or she is able. 3) Have Mom spend some time alone with the child. 4) Keep the baby away from the child as much as possible. 5) Anticipate unpredictable and uncomplimentary statements about the baby.
1, 2, 3, 5
The nurse is caring for a patient who delivered at 22 weeks' gestation and experienced a fetal demise when the newborn could not be resuscitated in the delivery room. Which actions will the postpartum nurse include in the immediate plan of care for this family? (Select all that apply.) 1) Clean and dress the baby. 2) Allow the family to hold the baby. 3) Obtain footprints and pictures of the baby. 4) Encourage the parents to cry over their loss. 5) Connect the family to a support group.
1, 2, 3, 5
24 A nurse is discussing the risks of cesarean delivery. Which of the following risks should the nurse include? (Select all that apply.) 1) Hemorrhage 2) Venous thrombosis 3) Nausea 4) Anxiety 5) Shock
1, 2, 5
25 A nurse is discussing a vacuum extractor as an instrument used for assisted vaginal delivery. The nurse informs the patient of which of the following indications may be required for an assisted vaginal delivery? (Select all that apply.) 1) Maternal exhaustion 2) Fetal distress 3) Cervix is not fully dilated 4) Unruptured amniotic membrane 5) Prolonged second stage of labor
1, 2, 5
21. Prior to discharging a patient following cephalic version, which teaching does the nurse provide? (Select all that apply.) 1) Teach the patient how to monitor fetal activity and when to call the provider. 2) Teach the patient how to monitor the fetal heart rate and when to call the provider. 3) Teach the patient the signs of the rupture of membranes and when to return to the hospital. 4) Teach the patient the signs and symptoms of labor and when to return to the hospital. 5) Teach the patient the importance of receiving RhoGAM prior to delivery
1, 3, 4
What does the nurse assess as part of the BUBBLE LE mnemonic? (Select all that apply.) 1) Episiotomy or abdominal incision 2) Bonding and attachment 3) Pain 4) Circulation in the legs 5) Gait
1, 3, 4
11. A nurse has made a call to the operating room to notify of an impending cesarean delivery. What is the priority intervention for the nurse to obtain? 1) Administer preoperative medications given. 2) Obtain a signed consent form. 3) Obtain a diet history for the past 8 hours. 4) |Insert an indwelling catheter.
2
13. A nurse is preparing discharge instructions for a patient post-cesarean section. Which should the nurse include in the teaching? (1) Plan to be in the hospital for 3 to 5 days. 2) Arrange for help at home. (3) Arrange for a ride home then resume driving the following day. 4) Resume normal activities.
2
17. A nurse is caring for a client undergoing an amnioinfusion due to oligohydramnios. Which symptom indicates that the solution is too cold? 1) Fetal tachycardia 2) Maternal chilling 3) Anxiety 4) Bladder infection
2
18. A patient asks the nurse why the provider has suggested an external cephalic version. What is the nurse's best response? 1) "The provider attempts the progression of labor." 2) "The provider attempts to reposition the fetus" 3) "The provider attempts to rupture the amniotic membranes" 4) "The provider attempts to move the fetus through the birth canal."
2
19. A patient asks the nurse the meaning of a Bishop's score. What is the nurse's best response? 1) "The score given to the baby when it is born" 2) "The score used to evaluate cervical ripening" 3) "The score given to determine fetal position" 4) "The score used to determine fetal heart rate"
2
2. The presence of fetal fibronectin (tFN) is confirmed in the vaginal fluid of a multipara patient at 25 weeks' gestation. The nurse recognizes that this patient is at risk for what complication? 1) Polyhydramnios 2) Preterm labor 3) Umbilical cord prolapse 4) Oligohydramnios
2
4. A pregnant patient reports leakage of fluid, vaginal discharge, and pelvic pressure but no contractions. What action should the nurse perform to verify the presence of amniotic fluid? 1) Amniocentesis 2) Nitrazine paper test 3) Cervical examination 4) Ultrasound
2
8. What will the nurse instruct the patient to do when the provider begins to apply traction to the vacuum extractor? 1) Hold her breath and count to 10. 2) Push with the contraction. 3) Turn to her left side. 4) Pant to avoid pushing.
2
A woman reports that she has not urinated since delivering 8 hours ago and says she has no urge to void despite drinking adequate fluids postpartum. The nurse attributes this to what? 1) The woman was dehydrated and has not fully hydrated yet to produce urine. 2) The woman's bladder tone is reduced, and she does not feel the urge to urinate. 3) The bladder has more room to expand and can hold more urine because of a smaller uterus. 4) The woman is experiencing a release of epinephrine, causing absence of bladder sensation.
2
Before massaging the fundus, the nurse should look for which of the following? | 1) Amount of lochia 2) Bladder distention 3) Breast engorgement 4) |Hemorrhoids
2
During which phase of postpartum adjustment to motherhood should the nurse provide praise and positive reinforcement to a mother who is learning to care for her infant? 1) Taking-in phase 2) Taking-hold phase 3) Letting-go phase 4) Transitioning from taking-in to taking-hold phase
2
The nurse is assessing a postpartum patient 1 hour after delivery. Where should the nurse expect to palpate the fundus? 1) Between the umbilicus and the symphysis pubis 2) Even with the umbilicus 3) Even with the symphysis pubis 4) 1 cm above the symphysis pubis
2
The nurse is assessing a student's knowledge of postpartum care. Which of the following statements regarding nursing care during the first hour after delivery is incorrect? (1) "I should observe the patient's peripads for the amount of lochia, color, odor, and the presence of clots." 2) "I should check vital signs, including pulse and blood pressure, every hour." 3) "I should palpate the fundus of the uterus for firmness and location every 15 minutes." 4) "The first hour after delivery is the most dangerous hour in childbearing because of the risk of hemorrhage after delivery."
2
The nurse is caring for a woman who delivered her third child 2 days ago and who says, "I am having pain; it feels like labor pain. I never experienced this with my other children, and it is worse when I breastfeed." Which is the nurse's priority response? 1) Further assess the pain's location, intensity, and frequency. 2) Explain the purpose of afterpains and reassure the patient. 3) Immediately obtain vital signs and monitor vital signs every 15 minutes. 4) Administer a narcotic analgesic to control pain.
2
The nurse is discussing nursing interventions for a patient with umbilical cord prolapse with a student nurse. Which statement by the student nurse indicates a need for further teaching? 1) "Two fingers of a gloved hand are placed in the vagina to lift the presenting part off the cord." 2) "The patient should be placed in a left side-lying position." 3) "The maternal hips should be elevated with two pillows." 4) "The patient should be in a Trendelenburg position."
2
The nurse recognizes which patient is at risk for precipitous labor? 1) A primigravida patient 2) A patient with a high pain threshold 3) A patient with gestational diabetes 4) A patient with a small pelvis
2
The nursing instructor observes a student providing care to an adolescent postpartum patient. Which statement made by the student indicates the need for further teaching? 1) "Let me show you a way to hold the baby when you're giving him a bath." 2) "Do you want your little friend to stay while you breastfeed?" 3) "You're going to be a great mother because you really want to learn." 4) "Do you have any questions or need help with anything?"
2
Which patient does the nurse recognize as not an appropriate candidate for amniotomy? 1) The woman who is at 41 weeks' gestation 2) The woman with a fetus in the breech presentation 3) The woman with a history of hypertension 4) The woman with a history of precipitous delivery
2
Which actions performed by the nurse demonstrate appropriate uterine massage for the postpartum patient? (Select all that apply.) 1) Positioning one hand at the fundus of the uterus 2) Pressing down until the fundus is palpated as a firm, hard, globular mass 3) Noting the position of the fundus (4) Placing one hand at the base of the uterus 5) Calling and informing the provider of the uterine location
2, 3,4
10. Which patient does the nurse assess as most likely to be able to deliver vaginally rather than requiring a cesarean delivery? 1) Active genital herpes 2) Fetal macrosomia 3) Multiple gestations 4) History of previous cesarean section
4
11. The fetus of a laboring patient is found to be in a breech position, and the nurse prepares the patient for a cesarean section. The patient asks, "Can't I try to deliver vaginally?" Which is the nurse's best response? (1) "If the fetus has CPD, it could result in serious complications for you and the baby." 2) "A fetus in the breech position causes labor to progress more slowly." 3) "We'll have to talk to the delivering provider to see if that is even possible." 4) "When the fetus is breech, a cesarean section is the safest choice for you and the baby."
4
16 A nurse is caring for a woman undergoing a trial of labor after cesarean (TOLAC). What signs is the nurse carefully observing for? 1) Gestational diabetes 2) Spontaneous labor 3) Anxiety 4) Uterine rupture
4
5. A patient is 39 weeks pregnant and is admitted for induction of labor. Her Bishop's score is 2. Which teaching does the nurse prepare for this patient? (1) Explain the process of inducing labor. 2) Describe the fetal monitoring equipment. 3) Explain the importance of monitoring fetal activity. |4) Explain the need for chemical or mechanical cervical ripening.
4
6. Which of the following is a fetal risk associated with post-term labor? 1) Perineal injury 2) Sudden infant death syndrome (SIDS) 3) Patent ductus arteriosus (PDA) 4) Meconium aspiration
4
7. Which outcome is most appropriate for a nursing diagnosis of Risk for Injury in a patient whose labor is induced? 1) Demonstrates and verbalizes reduced anxiety 2) Verbalizes understanding of the process of labor induction 3) Verbalizes readiness to become a mother |4) Maintains a good labor pattern with a reassuring FHR pattern
4
A laboring woman's membranes rupture, and the umbilical cord prolapses. The nurse notifies the provider and prepares the patient for an immediate cesarean section. The patient asks, "Why is a cesarean section necessary?" Which is the nurse's best response? 1) "It is our policy to always perform a cesarean section when there is a prolapsed cord." 2) "The baby could die if we don't rush to deliver it, and a cesarean section is the fastest method." 3) "A cesarean section is needed to save your life and prevent the risk of hemorrhaging." 4) |"The baby cannot be born vaginally without crimping off blood supply through the cord."
4
A new adolescent mother asks the nurse how to bathe her baby. Which is the nurse's best approach to teach her this procedure? (1) Have the new mother bathe the baby while the nurse talks her through the process. 2) Explain the procedure using pictures and diagrams. 3) Give the new mother a brochure and tell her to ask if she has any questions. 4) Let the new mother watch the nurse bathe the baby and then give a return demonstration tomorrow.
4
A postpartum patient who plans to relinquish her baby for adoption says, "I'm having second thoughts. Maybe I should keep the baby." Which is the nurse's best response? 1) "If you aren't sure, you should keep the baby until you make up your mind." 2)"You've made a promise to the adopting parents, and it's too late to change your mind." 3) "It is such a difficult decision to make. You must feel pulled in two directions." 4) "I can hear the indecision in your voice. Would you like to talk about it?"
4
A pregnant patient reports a decrease in fetal movement. The provider conducts an assessment and notifies the patient of an absent fetal heart rate (FHR). The patient asks the provider to check again. What stage of grief is the patient displaying? 1) Guilt 2) Anger 3) Depression 4) Denial
4
The nurse admits a patient who reports a desire to push. A quick assessment shows crowning of the fetal head. Which is the nurse's priority action? 1) Running to the nursing station and calling the provider 2) Hurrying to the supply room for a precipitous delivery pack 3) Washing the hands, applying gloves, and cleansing the perineum 4) Remaining calm and staying with the patient while calling for help
4
The nurse enters a postpartum patient's room and finds the father staring at the newborn in the bassinet with a contemplative look on his face. How should the nurse interpret this behavior? 1) The father may be a danger to the baby. 2) The father feels resentful toward the baby. 3) The father is uncertain about being a father. 4) The father is bonding with the baby.
4
The nurse examines a postpartum patient and notes a mass protruding from the vagina. What is the nurse's priority action? 1) Measure the size of the mass and document. 2) |Check vital signs. 3) Massage the fundus. 4) Notify the provider immediately.
4
The nurse is explaining afterpains to a postpartum patient. Which of the following statements is correct? 1) Afterpains are more painful for women who have not given birth previously. 2) (Oxytocin may be administered to resolve afterpains. 3) Afterpains usually last for 3 weeks. 4) |Afterpains can be noticed while breastfeeding as a result of nipple stimulation.
4
The nurse performs a focal postpartum assessment using the BUBBLE LE mnemonic. Which assessment finding is incorrect to document as part of this examination? (1) Breasts firm and tender; patient reports sore nipples 2) Fundus 2 cm below umbilicus, firm 3) Lochia pink, small amount of drainage 4) Pulse strong and regular at rate of 84 beats per minute
4
The nurse reviews a plan of care and sees the nursing diagnosis of Fear Related to Uncertainty of Pregnancy Outcome. Which priority nursing intervention should the nurse include when caring for this patient? 1) Reinforcing teaching provided to the patient by the provider and registered nurse 2) Providing information both verbally and in writing for the patient to refer to 3) Monitoring the patient and fetus for any nonreassuring signs and symptoms 4) Encouraging the participation of the support person in providing care
4
The postpartum nurse finds a patient who delivered 15 hours ago in shock with hypotension and tachycardia. Perineal assessment reveals hemorrhage and a mass protruding from the vagina. Upon reviewing the woman's medical record, the nurse recognizes which risk factor for this event? (1) Precipitous delivery 2) Premature delivery (3) Multiple pregnancy 4) Placenta accreta
4
