OB Exam III
A nurse is caring for a client at 38 weeks gestation who is diagnosed with chorioamnionitis. On which intervention should the nurse place priority?
Oxytocin
When will the mother who is has Herpes receive treatment for antiviral medication?
A month before pregnancy due date and are delivered by cesarean if lesions are present
What is the first interventions to resolve a shoulder dystocia?
McRoberts maneuver and the application of suprapubic pressure.
What 3 things cause PPH?
uterine atony, blood coagulopathies, or trauma.
What is often the first sign of shoulder dystocia?
Turtle sign
Infants born to hepatitis B-positive women should be given what type of treatment?
Hepatitis B vaccine and the hepatitis B immune globulin within 12 hours after birth
What are 3 risk factors for preterm labor? (things that can cause preterm labor?)
-Alcohol use during pregnancy -Lack of prenatal care -Victim of intimate partner violence
Which action should the nurse take when asked to apply suprapubic pressure during a birth with shoulder dystocia?
-Apply downward pressure just above pubic bone -Apply pressure between contractions -Apply pressure at an angle towards the face of the fetus
What is a risk factor for developing a postpartum infection?
-Diabetes type 1 -Prolonged labor -Cesarean birth
A nurse is assisting in the resuscitation of a newborn. The nurse would expect to stop resuscitation efforts when the newborn has no heartbeat and respiratory effort after which time frame?
10 mins
What Bishop score indicates a fvorable and successful vaginal delivery?
8 or higher
The nurse is caring for four clients in labor. Which client is at most risk for a postpartum hemorrhage?
A client who is G4 P3 with a history of hydramnios with this pregnancy
A nurse is developing a plan of care for a preterm infant experiencing respiratory distress. Which of the following would the nurse be least likely to include in this plan?
Administer oxygen using an oxygen hood.
What is the treatment for Chlamydia and Gonorrhea?
Antibiotics followed by re-testing 3 months later.
When caring for a client with premature rupture of membranes, the nurse observes an increase in the client's pulse. What should the nurse do next?
Assess the client's temperature
Which finding would the nurse most expect to find in a neonate born at 28 weeks' gestation who is diagnosed with intraventricular hemorrhage (IVH)?
Bulging fontanelles
For which potential neonatal infection does the nurse anticipate using ophthalmic erythromycin?
Chlamydia trachomatis
What qualifies as preterm labor?
Contractions with cervical change before 37 weeks
What is an obstetric emergency typically requiring immediate cesarean delivery
Cord prolapse
After determining that a newborn is in need of resuscitation, which of the following would the nurse do first?
Dry the newborn thoroughly
A newborn with severe meconium aspiration syndrome (MAS) is not responding to conventional treatment. Which of the following would the nurse anticipate as possibly necessary for this newborn?
ECMO- extracorporeal membrane oxygenation
A neonate with hyperbilirubinemia has been receiving phototherapy for 24 hours, but total bilirubin levels are not decreasing as expected. What assessment would the nurse prioritize based on this finding?
Fluid imbalance
A family member asks the nurse what caused the blood clot in the clients leg. Which factors increase the risk of DVT formation in the PP pt?
Fluid shift, higher clotting factors, venous stasis, bed rest
The nurse is teaching a group of students about the differences between a full-term newborn and a preterm newborn. The nurse determines that the teaching is effective when the students state that the preterm newborn has:
Greater surface area in proportion to weight
ssessment of a postpartum client reveals a firm uterus with bright-red bleeding and a localized bluish bulging area just under the skin at the perineum. The woman also is complaining of significant pelvic pain and is experiencing problems with voiding. The nurse suspects which of the following?
Hematoma
An infant has a grade 3 IVH. the nurse monitors the infant for which complication?
Hydrocephalus
What is a cord prolapse considered and what immediate intervention is carried out?
It is considered a medical emergency and an immediate caesarean is required.
Moments after birth, a neonate of 32 weeks' gestation develops asphyxia. Prior to resuscitation, the nurse would place the neonate's head in what position?
Keep the neonates head in the "sniffing" position
When describing newborns with birth-weight variations to a group of nursing students, the instructor identifies which variation if the newborn weighs 5.2 lb at any gestational age?
Low birth weight
What is often associated with shoulder dystocia?
Macrosomia and maternal diabetes
What are the two most common interventions to take out when there is shoulder dystocia?
McRobert's maneuver (Bringing legs as far back as possible) and Applying suprapubic pressure to try to rotate the shoulder anterior.
Which nursing interventions promote healthy development of the preterm neonate?
Nesting, non nutritive sucking, quite hours,covering the incubator
Is a vaginal exam indicated or contraindicated for a patient was has had PROM?
No! it puts the patient at risk for infection
What is the ideal fetal position for labor & delivery?
Occipital anterior
Which of the following would the nurse include when teaching a new mother about the difference between pathologic and physiologic jaundice?
Pathologic jaundice appears within 24 hours after birth.
A nurse is developing a plan of care for a newborn with omphalocele. Which of the following would the nurse include?
Placing the newborn into a sterile drawstring bowel bag
A group of students are reviewing risk factors associated with postpartum hemorrhage. The students demonstrate understanding of the information when they identify which of the following as associated with uterine tone?
Rapid tone, hydramnios
The nurse carefully documents the premature neonate's response to oxygen therapy, delivering only as much oxygen as is necessary to prevent the development of which complication?
Retinopathy of prematurity
A group of nursing students are reviewing the different types of congenital heart disease in infants. The students demonstrate a need for additional review when they identify which of the following as an example of increased pulmonary blood flow (left-to-right shunting)?
Tetralogy of Fallot
When does hypertonic uterine dysfunction occur and what is it?
it occurs during the latent phase and it is when the uterus is contracting too much/fast, irregular and ineffective.
The nurse is caring for a client at 36 weeks' gestation with a temperature of 101.2 F (38.4 C). Examination indicates that the client is leaking amniotic fluid. What is the nurse's priority concern based on these findings?
intrauterine infection
A viable neonate born to a 28-year-old multiparous client by caesarean birth because of placenta previa is diagnosed with respiratory distress syndrome (RDS). Which factor would the nurse explain as the factor placing the neonate at the greatest risk for this syndrome?
neonate born preterm
Important for the nurse to recognize that the cord should be handled as little as possible to prevent what complications?
spasm of the umbilical artery
What should bishop's score be taken?
when induction of labor is required or needed.
How can a HIV+ mother reduce the chances of transmitting the virus to thier newborn?
-cesarean delivery -do not breastfeed infant
A postpartum woman is diagnosed with metritis. The nurse interprets this as an infection involving which of the following?
Endometrium, Decidua, Myometrium
A newborn is diagnosed with meconium aspiration syndrome. When assessing this newborn, which of the following would the nurse expect to find?
Prolonged tachypnea, Intercostal retractions, Coarse crackles on auscultation
Lab test nurse expect to be used to monitor the fetus for this birth defect
alpha-fetoprotein levels
What are the 4 possible tests to confirm PROM?
-Ferning test -Nitrazine pH test -Arborization test -Meconium staining test
A client is 2 weeks past her due date, and her health provider is considering whether to induce labor. What conditions must be present before induction can take place?
-Fetus is in longitudinal lie -Cervix is ripe -Presenting part is engaged
On PP day 4, a client has a temp of 101.4 F. which findings would be consistent with a diagnosis of endometritis?
-Foul-smelling lochia -Tender uterus
Priority interventions the nurse implements first for hypovolemic shock:
-Increase IV fluids immediately -Prepare to adm IV oxytocin to assist with uterine contraction
What could soft tissue dystocia be caused by?
-scarring of the cervix -full bladder or bowel -pushing too soon before the cervix is totally dialated and can lead to swelling and soft tissue dystocia.
After teaching the parents of a newborn with periventricular hemorrhage about the disorder and treatment, which statement by the parents indicates that the teaching was successful?
Our newborn could develop a learning disability later on
The nurse prepares to administer a gavage feeding for a newborn with transient tachypnea based on the understanding that this type of feeding is necessary for which reason?
Oxygen demands need to be reduced
A group of nursing students are reviewing the literature in preparation for a class presentation on newborn pain prevention and management. Which of the following would the students be most likely to find about this topic?
Pain is frequently mistaken for irritability or agitation
When performing newborn resuscitation, which action would the nurse do first?
Suction the mouth and then the nose.
What is the most common reason for PPH?
uterine atony
The nurse is preparing discharge instructions for a pregnant patient experiencing preterm rupture of membranes. What should the nurse include in this teaching?
-Avoid douching -Measure oral temperature twice a day
A pregnant client is brought to the health care facility with signs of premature rupture of membranes (PROM). Which conditions and complications are associated with PROM?
-Prolapsed cord -Abruptio placenta -Preterm labor
When caring for a client with PPD, which assessment findings would confirm Diagnosis?
-Sense of isolation -Decreased energy -Hostility towards others
How much time to make it happen for intervention?
6 mins
The nurse frequently assesses the respiratory status of a preterm newborn based on the understanding that the newborn is at increased risk for respiratory distress syndrome because of which of the following?
Deficiency in surfactant
Prolonged labor with prolonged premature rupture of membranes can lead to what complication?
infection
What is an immediate intervention for a woman with a perineal hematoma?
insert a foley catheter?
During labor, a woman undergoing induction with oxytocin should be monitored frequently. Which assessment findings should result in the oxytocin being discontinued immediately and the health care provider notified?
-Contractions strong at 80 mmHg pressure with each contraction -Contractions lasting between 90-120 seconds occuring every 2-3 minutes
A mother is experiencing PPH shortly after delivery of her infant. Which nursing interventions would be appropriate for this client?
-Encourage the mother to breast-feed her infant if she is breast-feeding -Turn the mother on her side and inspect the area under her buttocks for blood -Encourage increased fluid intake -Monitor vitals every 15 mins
A nurse discovers a perineal hematoma in a woman who has recently given birth. Which interventions should the nurse make in this case?
-Estimate size of the hematoma and report it -Administer a mild analgesic as prescribed -Apply ice pack on site
A nurse is caring for a newborn of a mother who is positive for group B streptococcus (GBS). Which interventions will the nurse include in the infant's plan of care?
-Monitor for temperature instability -Assess for signs of respiratory distress -Assess for signs of hypoglycemia
Early onset infections based on which risk factors?
-Preterm labor -Prolonged rupture of membranes -Maternal fever
The client pushes the baby's head emerges. External rotation begins, but the baby's chin is drawn back just inside the vagina. The nurse recognizes that additional providers are needed in the delivery room. What emergency protocol does the nurse call?
Shoulder dystocia
Which of the following would alert the nurse to suspect that a preterm newborn is in pain?
Sudden high pitched cry
A nursing instructor is describing common problems associated with preterm birth. When describing the preterm newborns risk for perinatal asphyxia, the instructor includes which of the following as contributing to the newborns risk?
Surfactant deficiency and Immaturity of the respiratory control centers (prematurity)
Three days after giving birth, a client complains of being unable to breath. The nurse assess the client. Which findings by the nurse would be evidence of a pulmonary embolism?
Tachypnea, Orthopnea, Cough, Jugular vein distention
Which type of nutrition would the nurse expect to administer to a preterm infant who was born at 34 weeks gestation and has developed NEC?
Trophic feeding technique
A pregnant patient is diagnosed with preterm labor. What should the nurse tech the patient to help prevent the recurrence of preterm labor?
-Drink 8 to 10 glasses of fluid each day -Report any signs of ruptured membranes -Remain on bed rest except to use the bathroom
A group of students are reviewing the causes of postpartum hemorrhage. The students demonstrate understanding of the information when they identify which of the following as the most common cause?
Uterine atony
The nurse is conducting a class for postpartum women about mood disorders. The nurse describes a transient, self limiting mood disorder that affects mothers after birth. The nurse determines that the women understood the description when they identify the condition as postpart:
blues
A primigravid client at 39 weeks' gestation is admitted to the hospital in active labor. On admission, the client's cervix is 6 cm dilated. After 2 hours of active labor, the client's cervix is still dilated at 6 cm with 100% effacement at +1 station. Contractions were 3 to 4 minutes apart, and are now 5-6 minutes apart, lasting 45 seconds and of moderate intensity. The nurse determines that the client is most likely experiencing which problem?
hypotonic labor dystocia
Two weeks after vaginal birth, a client presents with low-grade fever. The client also reports loss of appetite and low energy levels. The HCP suspects an infection of the episiotomy. What S/S is most indicative of an episiotomy infection?
Foul smelling vaginal discharge
When does hypotonic uterine dysfunction occur and what is it?
It occurs during active phase, and it is the weak, irregular and ineffective pattern of contractions during active phase.
What is the most common fetal malpresentation?
Occiput Posterior (OP) position causing pt to have low back pain
What is concerning cord prolapse?
cord becomes compressed and the baby does not get enough oxygen.
