OB FINAL EXAM
The mother produces no Rh antibodies
At 28 weeks' gestation, an Rh-negative woamn receives RhoGAM. Which of the following would indicate that the medication is effective?
Performing effleurage
In addition to breathing with contractions, which of the following actions can help a woman in labor to work with the pain of the first stage of labor?
The physician orders: magnesium sulfate 4 gram loading dose to infuse over 20 minutes; then a maintenance dose of 1 gram per hour via continuous infusion. The pharmacy has sent 1000 ml 0.9% sodium chloride with 80 grams of magnnesium sulfate. How many mL/hr will the nurse set the pump to infuse the loading dose?
The physician orders: magnesium sulfate 4 gram loading dose to infuse over 20 minutes; then a maintenance dose of 1 gram per hour via continuous infusion. The pharmacy has sent 1000 ml 0.9% sodium chloride with 80 grams of magnnesium sulfate. How many mL/hr will the nurse set the pump to infuse the loading dose?
0 station
When the fetal head is at the level of the ischial spine, it is said that the station of the fetal head is:?
weighs the baby at the same time each day for accuracy
When weighing a baby, the nurse:
During the second stage of labor
When would the nurse expect to see the monitor tracing shown above?
Blink, cough, sneeze, and gag
Which of the following groups of newborn reflexes below are present at birth and remain unchanged through adulthood?
HCG level and ultrasound
Which of the following tests would be performed to determine if a client is having an ectopic pregnancy?
20 weeks' gestation
During a clinical visit, a client states she has begun to feel fetal movement. When is fetal movement first felt by a primagravida woman?
Acute hemolytic disease
During a prenatal examination, the nurse draws blood from a client who is Rh negative. The nurse explains that an indirect Coombs test will be performed to predict whether the fetus is at risk for which condition?
cervical dilation and effacement
During the initial assessment of a client in early labor, the nurse performs a vaginal exam to obtain information about the
The response of the FHR to uterine contractions (UCs)
Fetal well-being during labor is assessed by:
A 34 week gestation with baseline of 130 bpm, moderate variability with recurrent variable decelerations
You are monitoring four clients in labor and delivery on the central monitor. Which client would you report as having a "Category II" reading?
Baby with APGAR 9/9, weight 4660 grams
You have several babies that were admitted into the neonatal nursery. Which baby should you assess first?
Client's weight
You receive an obese 37-year-old-client from the labor and delivery recovery room. Your patient has had a lengthy labor (30 hours) and she had to be delivered by forceps. She delivered a 9lb 7oz baby boy vaginally 2 hours ago. You are assessing your postpartum patient and know that which characteristic is not one of the criteria that would place a client at risk for postpartum hemorrhage?
Vastus lateralis muscle
You receive an order to administer Vitamin K injection to a newborn. The nurse knows that this is the most appropriate site for the injection?
2 mL/hr
he provider orders pitocin 2 milliunits per minute every 15 minutes until contractions are every two-three minutes with duration of 50-60 seconds. The pharmacy sends a bag label Pitocin 30 units in 500 mL of Latated Ringers. The nurse sets the pump to deliver the inital rate at
Checking deep tendon reflexes Checking respiratory rate Noting urine output
A 19 year old G1P0 patient at 40 weeks' gestation who is in labor is being treated with magnesium sulfate for preeclampsia. What are the priority assessments with this medication?Select all that apply.
auscultates the apical rate for 1 minute
A 2-day old, full-term newborn has had an uneventful neonatal course. What is the proper way to assess a newborn's pulse?
click on belly button
A 20-week gestation client is at the prenatal clinic for a check up. Click the area on the abdomen where the nurse would expect to find the fundal height.
"A frequent cough"
A 21-year-old primagravida, 36 weeks' gestation, has cardiac disease, class III, as a result of having had childhood rheumatic fever. During a prenatal visit the nurse reviews the signs of cardiac decompensation with her. The nurse recognizes that the client understands these signs and symptoms if she states: "I would notify my doctor if I have:
Epigastric pain
A 26 week-gestation woman is diagnosed with severe preeclampsia. Which of the following would require further assessment by the nurse?
draw liver enzymes Betamethasone Magnesium Sulfate biophysical profile
A 32 week gestation pregnant client is hospitalized for a blood pressure of 162/112, 3+ protienuria, blurred vision and decreased urine output. Which of the following would the nurse anticipate to implement initially in the plan of care?Select all that apply
sternal retractions
A baby was born prematurely at 35 weeks' gestation. Realizing that he may have a surfactant deficiency that may lead to respiratory distress, the nurse observes specifically for:
provides extra fluids to prevent dehydration
A newborn undergoing phototherapy experiences increased urine output and loose stools. What is the priority nursing action?
encourages the parents to express their feelings, and explain that they may experience different feelings
After a prolapse of the fetal umbilical cord, a woman has an emergency cesarean section under general anesthesia, and the baby died. In order to facilitate the grief process for the woman and her partner, the nurse
work from front to back when placing the ice pack
After delivery, the nurse is preparing an ice pack to place on a client's episiotomy. The nurse should:
Temperature of 38° C (100.4° F) or higher on 2 successive days starting 24 hours after birth
One of the first symptoms of puerperal infection to assess for in the postpartum woman is:
assists the woman to empty her bladder
Palpation of the fundus 18 hours after birth reveals that it is firm, 2 fingerbreaths above the umbilicus, and deviated to the right. The nurse initially:
Rh+ newborns who have been exposed to Rh+ antibodies from their RH-mothers
Pathologic hyperbilirubinemia, as indicated by the appearance of jaundice in the first 24 hours, is most likely to occur in:
grunting
The nurse is caring for a 15 minute old newborn. Which of the following assessment findings would require futher interventions by the nurse?
blood component replacement therapy
The nurse is caring for a client who has been diagnosed with placenta accreta. The nurse anticipates the initial management for this client will be
Check the fetal heart tones
The nurse is caring for a woman admitted for preterm labor at 35 weeks gestation. The woman's husband tells the nurse, "Something happened, my wife's bed is wet". What is the nurse's priority action?
A woman with severe preeclampsia on magnesium sulfate whose labor is being induced
The nurse is caring for the women listed below. The client who is at the highest risk for post partum complications is
The neonatal gut is sterile
The pediatrician writes an order for a term newborn for Vitamin K 1 mg IM. Which of the following responses provides a rationale for this order?
2mL/hr
The physician orders Pitocin at 2 miliunits per minute. The pharmacy sends a bag labeled 30 units in 500mL. How many mL/hr will the nurse set the pump for the inital dose?
Macrosomic fetus Cesarean birth Stillbirth
You are caring for a 28 week gestation client with pregestational diabetes. Which risk factors would this nurse know to look for due to this condition?
telling the mother that the stool is normal
As the nurse helps a new mother change the diaper of her 16-hour-old newborn, the mother expresses concern that the bowel movement is almost black in color. She asks the nurse if something is wrong. The nurse responds to this mother's concern by:
Go to the parents, introduce himself or herself, and gently encourage them to come meet their infant; explain the equipment first and then focus on the newborn
A newborn was admitted to the NICU after being delivered at 29 weeks of gestation to a 28-year-old multiparous, married, Caucasian female whose pregnancy was uncomplicated until premature rupture of membranes and preterm birth. The newborn's parents arrive for their first visit after the birth. The parents walk toward the bedside but remain approximately 5 feet away from the bed. The nurse's most appropriate action would be to:
"What makes you think you are in labor?"
A pregnant client, 36 weeks' gestation, calls the clinic and tells the nurse that she thinks she is in labor. What is the nurse's best response?
"The bacteria is living in your vagina. It will not hurt you but we will give you IV antibiotics while you are in labor to protect your baby from getting sick."
A client at 36 weeks' gestation has tested positive for Group B streptococci. Which of the following comments by the nurse is appropriate at this time?
April 12, 2021
A client had a last menstrual period of July 5th, 2020. Her estimated date of delivery (EDD) should be which of the following?
3 ml
A client is admitted for labor induction at 0500. The physician orders oxytocin to be infused at 2 milliunits per minute, and increased by 2 milliunits per minute every 30 minutes. The nurse adds 40 units of oxytocin to 1000 ml of normal saline. How many ml per hour will the nurse increase the pump at 0530?
Palpating the client's abdomen and noting the onset, duration, and intensity of the contraction
A client is in active labor. The nurse has applied the external fetal and uterine monitor to the client's abdomen. How would the nurse properly assess the uterine activity?
Ask her to lie down in a side-lying position and assess her contractions
A client presents to the emergency room in preterm labor. What should the nurse do first?
applying an ice pack to the client's perineum during the first hour after birth and intermittently after that.
A client received an episiotomy that was sutured after the delivery of her baby. What is the most appropriate nursing measure to help prevent vulvar or vaginal hematoma?
Type and Screen Glucose Tolerance Test Vital Signs
A client with Type 1 diabetes comes to the clinic for her first prenatal visit. What testing would be performed at this time?
Seizure precautions
A client with severe preeclampsia is admitted to the hospital with a blood pressure of 162/111, 3+ proteinuria, and severe pitting edema on the lower extremities. Which of the following would be most important to include in the plan of care for the client?
assure continued milk production
A couple has had their third baby by cesarean birth. The woman's incision has become infected and she has been placed in isolation. Since she cannot breast-feed her baby while she is in isolation, the nurse instructs her to pump her breasts. The most important reason for pumping her breasts is to
fetus has descended down into the birth canal
A laboring primigravida complains of increasing rectal pressure. A vaginal exam reveals 8cm, 100 %, +2, LOA. What would the nurse conclude?
administers oxygen by face mask
A multigravid client in active labor at term suddenly sits up and says, "I can't breath! My chest hurts really bad!" The client's skin begins to turn a dusky gray color. After calling for assistance, the nurse next
Monitor renal function and cardiac function closely Keep calcium gluconate on hand in case of a magnesium sulfate overdose Monitor I and O's hourly Notify the physician if urinary output is less than 30 mL per hour Monitor deep tendon reflexes hourly
A nurse is caring for a pregnant client with severe preeclampsia who is receiving IV magnesium sulfate. Select all nursing interventions that apply in the care for this client.
fold the diaper below the cord to speed drying
A nurse teaching new parents about cord care tells them
133
A pregnant client diagnosed with severe PIH is admitted for treatment. The clinician orders Magnesium sulfate intravenously. Ordered: Magnesium sulfate 4 gram loading dose administered over 30 minutes; Maintenance dose 1 gram per hour. The nurse adds 60 grams of magnesium sulfate to 1000 ml of 0.9% NaCl. How many mL/hr would the nurse set the pump initially?
Bleeding in the gums, petechiae, and purpura.
A pregnant client in the last trimester has been admitted to the hospital with a diagnosis of severe preeclampsia. Which of the following assessment findings would warrant futher investigation?
Respirations of 10 per minute
A pregnant client is receiving magnesium sulfate for the management of preeclampsia. A nurse determines the client is experiencing toxicity from the medication if which of the following is noted on assessment?
"Rigid, painful abdomen, increased resting tone on EFM."
A pregnant woman at 38 weeks' gestation is diagnosed with abruptio placentae. Which of the following would the nurse expect to find on assessment?
Meconium aspiration, hypoglycemia, and dry, cracked skin
A pregnant woman was admitted for induction of labor at 43 weeks of gestation with sure dates. A nonstress test in the obstetrician's office revealed a nonreactive tracing. Upon artificial rupture of membranes, thick, meconium-stained fluid was noted. The nurse caring for the infant after birth should anticipate which of the following?
Reverse fluid, electrolyte, & acid-base imbalances that are present using IV therapy.
A pregnant woman, 13 weeks' gestation, is admitted to the hospital with a diagnosis of hyperemesis gravidarum. What is the highest priority for this client?
Urinary frequency Amenorrhea Nausea and vomiting
A prenatal client is informing the nurse of her presumed signs of why she may be pregnany. Which of the following findings would the nurse determine are presumptive signs of pregnancy?Select all that apply
Perform fundal massage
A primary nursing responsibility when caring for a woman experiencing an obstetric hemorrhage associated with uterine atony is to:
A darkened room as close to the nurse's station as possible
A primigravid client at 37 weeks' gestation who has been diagnosed with preeclampsia is to be admitted to high risk antenatal unit. Which of the following rooms is most appropriate for this client?
Human papillomavirus (HPV)
A viral sexually transmitted infection that affects most people in the United States today is:
encourage breast feeding
A woman has given birth prior to the arrival of the physician. The most appropriate nursing action to decrease postpartal bleeding is to
decreased mobility and lowered resistance put her at risk for lung infection, and the exercises will help prevent that
A woman has just had her first baby by cesarean birth. This is her first postoperative day. She asks the nurse why she has to turn, cough, and deep breath when it causes her incision to hurt so much. The nurse should tell her that:
Meperidine (Demerol)
A woman in active labor receives an analgesic, an opioid agonist. Which medication relieves severe, persistent, or recurrent pain, but should be used cautiously in women with cardiac disease?
Monitor the maternal blood pressure
A woman in labor has just received an epidural block. What is the most important nursing intervention to perform?
determine if the bleeding slows to normal or remains large
A woman who is 4 hours postpartum ambulates for the first time to the bathroom and suddenly has a large gush of lochia rubra. The nurse's first action is to
frequency of uterine contractions: every 1.5 to 2 minutes with a duration of 90 seconds
A woman's labor is being induced with oxytocin. The nurse assesses the woman's status and that of her fetus just before an infusion increment of 2 milliunits/min. The nurse discontinues the infusion and notifies the woman's physician when assessments reveal
"I'll need to come back at 37 weeks' gestation to have my sutures cut."
A woman, at 15 weeks' gestation is admitted to the maternity unit for a McDonald's cerclage procedure. What statement would indicate that patient teaching has been successful?
Perineum is red and edematous; painful with red hemorrhoids.
A woman, para 1, gravida 1, gave birth vaginally to a baby about 24 hours ago. Which of the following assessment findings should be reported to the health care provider immediately?
places the infant under a radiant warmer
After suctioning to clear the airway of a term neonate who appears in good condition after a spontaneous vaginal delivery, the nurse
promote parent-newborn interaction
An important nursing intervention the nurse performs during the third stage of labor is to
Abdominal distention, temperature instability, and grossly bloody stools
Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. What would the nurse assess for?
Initially allow a natural evacuation of the products of conception.
Signs of a missed abortion are noted in a woman at 8 weeks' gestation. The nurse anticipates that an appropriate management approach for this type of abortion is
Obtain a medical order for an internal monitor
The external monitor shows a fetal heart rate of 140 with decreased variability for the previous 2 hours. What is the priority nursing action?
The client feels like bearing down
The following are signs that the placenta has detached except?
Supervise while the woman holds her newborn
The nurse has administered diphenhydramine (Benadryl) to a post-cesarean client who is experiencing side effects from the parenteral morphine sulfate that was administered 30 minutes earlier. Which of the following actions should the nurse perform following the administration of the medication?
4
The nurse is assessing the APGAR score on a newborn infant at 1-minute of age. The infant is limp, grimaces in response to stimulation, gasping respirations, an HR or 106 beats per minute and is cyanotic. The nurse would reports the APGAR to the physician as
apical rate of 150 BPM and was irregular for a period of time following an episode of crying
The nurse is assessing the apical rate of a newborn. The nurse recognizes as an expected assessment finding is
Ischial spines
The nurse is assessing the fetal station during a vaginal examination. Which of the following structures should the nurse palpate?
turn the woman on her side
The nurse notes variable decelerations on the fetal heart monitor. The nurse's first actions is to
whose rubella titer is less than 1:8
The nurse prepares to administer, the rubella vaccine to a postpartum client
intensity of uterine contractions
The nurse recalls the measurement that requires the use of an intrauterine pressure catheter in order to be accurate is the:
Facial edema
The nurse teaches a pregnant client about danger signs of pregnancy. Which of the following should the nurse report to the provider immediately?
inserting a large-guage intravenous catheter
The nursing action with the highest priority after admitting a multigravid client at 36 weeks' gestation admitted to the labor unit, with a probable diagnosis of abruptio placenta, is (assume action is ordered)
Magnesium sulfate and terbutaline
To prevent preterm labor from progressing, drugs are usually prescribed to stop contractions. The nurse may anticipate administering which medications?
Assess the client's apical pulse
What assessments should the nurse perform prior to giving the scheduled dose of terbutaline to a client, with a history of preterm labor?
Bedrest, pad counts and pelvic rest.
What is the appropriate management for a 8 week gestation client who has slight bleeding, mild uterine cramping with a closed cervix?
Pulse
What is the highest priority assessment the nurse makes for a third trimester gravid client that is bleeding?
Using proper breastfeeding techniques
What is the priority instruction to help prevent acute mastitis?
the pads should be applied and removed in a front-to-back direction
What is the priority teaching when teaching the postpartum woman about peripads?
establish IV access
When assessing a post partum client the nurse finds that the client has rapid and shallow respirations, weak irregular pulse with cool pale skin. What is the priority nursing action?
applies suprapubic pressure as the nurse midwife delivers the baby
When assisting with the delivery of an infant experiencing shoulder dystocia, the nurse
prevention
When caring for a client who is at risk for a post partum infection the nurse understands that the most effective treatment for infection is
hypoglycemia
When caring for a newborn, the nurse must be alert for signs of cold stress such as
IV heparin
When doing a post partum assessment, the nurse observes swelling in the right calf. The client is complaining of calf pain and unilateral leg pain. What is the inital treatment for this?
Change the woman's position
While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate (FHR) for five sequential contractions begins to decelerate after the peak of the contraction and does not recover to baseline until after the contraction is complete. What is the nurse's priority intervention?
assess the infant's blood glucose level
While performing an admission assessment on a term newborn, the nurse notes poor muscle tone and slight jitterness. The appropriate nursing action is to
to promote nipple attachment
Why would a nurse provide non-nutritive sucking when providing gavage feeding to an infant?