OB HESI REVIEW

List the symptoms of water intoxication resulting from the effect of Pitocin (oxytocin) on the antidiuretic hormone (ADH).

Nausea and vomiting, headache, and hypotension

Name the major discomforts of the first trimester and one suggestion for amelioration of each

Nausea and vomiting: crackers before rising; fatigue: rest periods and naps and 7 to 8 hours of sleep at night

State five symptoms of respiratory distress in the newborn.

Tachypnea, dusky color, flaring nares, retractions, and grunting

State three actions the nurse should take when hypotension occurs in a laboring client.

Turn client to left side. Administer O2 by mask at 10 L/min. Increase speed of intravenous infusion (if it does not contain medication).

. FHR can be auscultated by Doppler at _____ weeks' gestation.

10 to 12

What is considered a good Apgar score?

7-10

What is the priority nursing action after spontaneous or AROM?

Assessment of the FHR

What is the main action of magnesium sulfate?

CNS depression (seizure prevention)

An antenatal client is informing the nurse of her prenatal signs and symptoms. Which of the following findings would the nurse determine are presumptive signs of pregnancy? Select all that apply. 1. Amenorrhea. 2. Breast tenderness. 3. Quickening. 4. Frequent urination. 5. Uterine growth.

1, 2, 3, and 4 are correct. 1. Amenorrhea is a presumptive sign of pregnancy. 2. Breast tenderness is a presumptive sign of pregnancy. 3. Quickening is a presumptive sign of pregnancy. 4. Frequent urination is a presumptive sign of pregnancy

The nurse is providing anticipatory guidance to a woman in her second trimester regarding signs/symptoms that are within normal limits during the latter half of the pregnancy. Which of the following comments by the client indicates that teaching was successful? Select all that apply. 1. "During the third trimester I may experience frequent urination." 2. "During the third trimester I may experience heartburn." 3. "During the third trimester I may experience nagging backaches." 4. "During the third trimester I may experience persistent headache." 5. "During the third trimester I may experience blurred vision."

1, 2, and 3 are correct. 1. Frequency is seen once lightening, or the descent of the fetus into the pelvis, has occurred. 2. Heartburn is a common complaint of pregnant women. 3. Backaches are common complaints of pregnant women

The client in labor is diagnosed with pregnancy-induced hypertension and has preeclampsia. Which interventions should the nurse implement? Select all that apply. 1. Monitor the intravenous (IV) magnesium sulfate. 2. Check the client's telemetry monitor. 3. Assess the client's deep tendon reflexes. 4. Administer furosemide (Lasix) intravenous push (IVP). 5. Notify the nursery when delivery is imminent or has occurred.

1, 3, and 5 are correct. 1. Magnesium sulfate, a uterine relaxant, is the drug of choice to help prevent seizures. The medication relaxes smooth muscles and reduces vasoconstriction, thus promoting circulation to the vital organs of the mother and increasing placental circulation to the fetus 3. The deep tendon reflexes are monitored to determine the effectiveness of the magnesium sulfate. 5. The nursery should be notified of the delivery so it will be prepared for the neonate. Because the client is in labor, the baby will be born within a reasonable time frame

The labor and delivery nurse is performing a vaginal examination and assesses a prolapsed cord. Which intervention should the nurse implement first? 1. Place the client in the Trendelenburg position. 2. Ask the father to leave the delivery room. 3. Request the client not to push during contractions. 4. Prepare the client for an emergency C-section.

1. A prolapsed cord is an emergency situation because the prolapsed cord could compromise the fetus's blood supply. Placing the client in the Trendelenburg position will cause the fetus to reverse back into the uterus, which will take the pressure off the umbilical cord. The safety of the fetus is priority.

List three signs of placental separation.

1. Gush of blood 2. Lengthening of cord 3. Globular shape of uterus

. A 2-day-old breastfeeding baby born via normal spontaneous vaginal delivery has just been weighed in the newborn nursery. The nurse determines that the baby has lost 3.5% of the birth weight. Which of the following nursing actions is appropriate? 1. Do nothing because this is a normal weight loss. 2. Notify the neonatologist of the significant weight loss. 3. Advise the mother to bottle feed the baby at the next feed. 4. Assess the baby for hypoglycemia with a glucose monitor

1. The baby has lost less than 4% of its birth weight. Babies often lose between 5% and 10% of their birth weight. A loss greater than 10% is considered pathological.

Immediately after a woman spontaneously ruptures her membranes, the nurse notes a loop of the umbilical cord protruding from the woman's vagina. Which of the following actions should the nurse perform first? 1. Put the client in the knee-chest position. 2. Assess the fetal heart rate. 3. Administer oxygen by tight face mask. 4. Telephone the obstetrician with the findings

1. The first action the nurse should take is to place the woman in the knee-chest position.

Which of the following long-term goals is appropriate for a client, 10 weeks' gestation, who is diagnosed with gestational trophoblastic disease (hydatidiform mole)? 1. Client will be cancer free 1 year from diagnosis. 2. Client will deliver her baby at full term without complications. 3. Client will be pain free 3 months after diagnosis. 4. Client will have normal hemoglobin and hematocrit at delivery

1. This long-term goal is appropriate.

. A full-term newborn was just born. Which nursing intervention is important for the nurse to perform first? 1. Remove wet blankets. 2. Assess Apgar score. 3. Insert eye prophylaxis. 4. Elicit the Moro reflex

1. When newborns are wet they can become hypothermic from heat loss resulting from evaporation. They may then develop cold stress syndrome.

The nurse midwife tells a client that the baby is growing and that ballottement was evident during the vaginal examination. How should the nurse explain what the nurse midwife means by ballottement? 1. The nurse midwife saw that the mucous plug was intact. 2. The nurse midwife felt the baby rebound after being pushed. 3. The nurse midwife palpated the fetal parts through the uterine wall. 4. The nurse midwife assessed that the baby is head down.

2

A client is in the 10th week of her pregnancy. Which of the following symptoms would the nurse expect the client to exhibit? Select all that apply. 1. Backache. 2. Urinary frequency. 3. Dyspnea on exertion. 4. Fatigue. 5. Diarrhea.

2 and 4 are correct. 1. Backaches usually do not develop until the second trimester of pregnancy. 2. The woman will likely complain of urinary frequency. 3. Dyspnea is associated with the third trimester of pregnancy. 4. Most women complain of fatigue during the first trimester. 5. Diarrhea is not a complaint normally heard from prenatal clients.

Which priority intervention should the nurse implement for the 38-week gestation client who is receiving epidural anesthesia? 1. Place the client in the fetal position. 2. Assess the client's respiratory rate. 3. Pre-hydrate the client with intravenous fluid. 4. Ensure the client has been NPO for 4 hours

2. If the anesthesia ascends the spinal cord the client will quit breathing; therefore, this is the priority intervention.

A neonate has an elevated bilirubin and is slightly jaundiced on day 3 of life. What is the probable reason for these changes? 1. Hemolysis of neonatal red blood cells by the maternal antibodies. 2. Physiological destruction of fetal red blood cells during the extrauterine period. 3. Pathological liver function resulting from hypoxemia during the birthing process. 4. Delayed meconium excretion resulting in the production of direct bilirubin.

2. With lung oxygenation, the neonate no longer needs large numbers of red blood cells. As a result, excess red blood cells are destroyed. Jaundice often results on days 2 to 4.

A nurse notes that a 6-hour-old neonate has cyanotic hands and feet. Which of the following actions by the nurse is appropriate? 1. Place child in an isolette. 2. Administer oxygen. 3. Swaddle baby in a blanket. 4. Apply pulse oximeter.

3. The baby's extremities are cyanotic as a result of the baby's immature circulatory system. Swaddling help

Which of the following findings should the nurse expect when assessing a client, 8 weeks' gestation, with gestational trophoblastic disease (hydatidiform mole)? 1. Protracted pain. 2. Variable fetal heart decelerations. 3. Dark brown vaginal bleeding. 4. Suicidal ideations.

3. The condition is usually diagnosed after a client complains of brown vaginal discharge early in the "pregnancy."

Immediately prior to an amniotomy, the external fetal heart monitor tracing shows 145 bpm with early decelerations. Immediately following the procedure, an internal tracing shows a fetal heart rate of 120 with variable decelerations. A moderate amount of clear, amniotic fluid is seen on the bed linens. The nurse concludes that which of the following has occurred? 1. Placental abruption. 2. Eclampsia. 3. Prolapsed cord. 4. Succenturiate placenta

3. The drop in fetal heart rate with variable decelerations indicates that the cord has likely prolapsed.

A pregnant woman informs the nurse that her last normal menstrual period was on September 20, 2012. Using Nagele's rule, the nurse calculates the client's estimated date of delivery as: 1. May 30, 2013. 2. June 20, 2013. 3. June 27, 2013. 4. July 3, 2013

3. The estimated date of delivery is June 27, 2013.

An ultrasound of a fetus's heart shows that normal fetal circulation is occurring. Which of the following statements should the nurse interpret as correct in relation to the fetal circulation? 1. The foramen ovale is a hole between the ventricles. 2. The umbilical vein contains oxygen-poor blood. 3. The right atrium contains both oxygen-rich and oxygen-poor blood. 4. The ductus venosus lies between the aorta and pulmonary artery

3. The right atrium does contain both oxygen-rich and oxygen-poor blood.

A gravid woman, who is 42 weeks' gestation, has just had a 20-minute nonstress test (NST). Which of the following results would the nurse interpret as a reactive test? 1. Moderate fetal heart baseline variability. 2. Maternal heart rate accelerations to 140 bpm lasting at least 20 seconds. 3. Two fetal heart accelerations of 15 bpm lasting at least 15 seconds. 4. Absence of maternal premature ventricular contractions.

3. This is the definition of a reactive nonstress test—there are two fetal heart accelerations of 15 bpm lasting 15 or more seconds during a 20-minute period

The 34-week pregnant patient in the labor and delivery unit is on a magnesium sulfate, an anticonvulsant, intravenous drip for eclampsia. The labor and delivery nurse assesses the patient's reflexes as absent with repeated stimulation. Which nursing intervention should the nurse implement first? 1. Notify the obstetrician. 2. Document the finding as absent. 3. Have another nurse assess the reflexes. 4. Turn off the magnesium drip.

4 The adverse effects of parenterally administered magnesium sulfate usually are the result of magnesium intoxication. These include flushing, sweating, hypotension, depressed reflexes, flaccid paralysis, hypothermia, circulatory collapse, and cardiac and central nervous system depression proceeding to respiratory paralysis. This patient is demonstrating magnesium toxicity. The nurse should immediately discontinue the magnesium

The mother notes that her baby has a "bulge" on the back of one side of the head. She calls the nurse into the room to ask what the bulge is. The nurse notes that the bulge covers the right parietal bone but does not cross the suture lines. The nurse explains to the mother that the bulge results from which of the following? 1. Molding of the baby's skull so that the baby could fit through her pelvis. 2. Swelling of the tissues of the baby's head from the pressure of her pushing. 3. The position that the baby took in her pelvis during the last trimester of her pregnancy. 4. Small blood vessels that broke under the baby's scalp during birth

4. Cephalhematomas are subcutaneous swellings of accumulated blood from the trauma of delivery. The bulges may be one-sided or bilateral and the swellings do not cross suture lines.

Normal blood glucose in the term neonate is _____.

40-80 mg/dL

A term newborn needs to take in _____ calories per pound per day.After the initial weight loss is sustained, the newborn should gain _____ per day.

50; 1 oz, or 30 g

What is the most common cause of uterine atony in the first 24 hours postpartum?

A full bladder

List three symptoms of abruptio placentae

Abruptio placentae: fetal distress;rigid, boardlike abdomen; pain; dark-red or absent bleeding

It has been 12 hours since the client's delivery of a newborn. The nurse assesses the client for the process of involution and documents that it is progressing normally when palpation of the client's fundus is at which level? 1. At the level of the umbilicus 2. One finger breadth below the umbilicus 3. Two finger breadths below the umbilicus 4. Midway between the umbilicus and the symphysis pubis

Answer: 1 Rationale: The term "involution" is used to describe the rapid reduction in size and the return of the uterus to a normal condition similar to its nonpregnant state. Immediately after the delivery of the placenta, the uterus contracts to the size of a large grapefruit. The fundus is situated in the midline between the symphysis pubis and the umbilicus. Within 6 to12 hours after birth, the fundus of the uterus rises to the level of the umbilicus. The top of the fundus remains at the level of the umbilicus for about a day and then descends into the pelvis approximately one finger breadth on each succeeding day

The nurse in a labor room is performing a vaginal assessment on a pregnant client in labor. The nurse notes the presence of the umbilical cord protruding from the vagina. What is the first nursing action with this finding? 1. Gently push the cord into the vagina. 2. Place the client in Trendelenburg's position. 3. Find the closest telephone and page the primary health care provider stat. 4. Call the delivery room to notify the staff that the client will be transported immediately.

Answer: 2 Rationale: When cord prolapse occurs, prompt actions are taken to relieve cord compression and increase fetal oxygenation. The client should be positioned with the hips higher than the head to shift the fetal presenting part toward the diaphragm. The nurse should push the call light to summon help, and other staff members should call the primary health care provider and notify the delivery room. If the cord is protruding from the vagina, no attempt should be made to replace it because to do so could traumatize it and reduce blood flow further. Also as a first action, the examiner should place a gloved hand into the vagina and hold the presenting part off the umbilical cord. Oxygen, 8 to 10 L/minute, by face mask is administered to the client to increase fetal oxygenation.

. The nurse is assessing a pregnant client in the second trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which assessment finding should the nurse expect to note if this condition is present? 1. Soft abdomen 2. Uterine tenderness 3. Absence of abdominal pain 4. Painless, bright red vaginal bleeding

Answer: 2 Rationale: Abruptio placentae is the premature separation of the placenta from the uterine wall after the twentieth week of gestation and before the fetus is delivered. In abruptio placentae, acute abdominal pain is present. Uterine tenderness accompanies placental abruption, especially with a central abruption and trapped blood behind the placenta. The abdomen feels hard and board-like on palpation as the blood penetrates the myometrium and causes uterine irritability. A soft abdomen and painless, bright red vaginal bleeding in the second or third trimester of pregnancy are signs of placenta previa

The nurse is performing an assessment on a mother who just delivered a healthy newborn. When checking the uterine fundus the nurse should expect to note that the fundus is positioned at which location? 1. To the right of the abdomen 2. At the level of the umbilicus 3. Above the level of the umbilicus 4. One fingerbreadth above the symphysis pubis

Answer: 2 Rationale: Immediately after delivery, the uterine fundus should be at the level of the umbilicus or one to three fingerbreadths below it and in the midline of the abdomen. A fundus that is not located in the midline may indicate a full bladder. If the fundus is above the umbilicus, this may indicate that blood clots in the uterus need to be expelled by fundal massage

. The nurse has created a plan of care for a client experiencing dystocia and includes several nursing actions in the plan of care. What is the priority nursing action? 1. Providing comfort measures 2. Monitoring the fetal heart rate 3. Changing the client's position frequently 4. Keeping the significant other informed of the progress of the labor

Answer: 2 Rationale: Dystocia is difficult labor that is prolonged or more painful than expected. The priority is to monitor the fetal heart rate. Although providing comfort measures, changing the client's position frequently, and keeping the significant other informed of the progress of the labor are components of the plan of care, the fetal status would be the priority

The nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which risk associated with placenta previa? 1. Infection 2. Hemorrhage 3. Chronic hypertension 4. Disseminated intravascular coagulation

Answer: 2 Rationale: In placenta previa, the placenta is implanted in the lower uterine segment. The lower uterine segment does not contain the same intertwining musculature as the fundus of the uterus, and this site is more prone to bleeding. Options 1, 3, and 4 are not risks that are related specifically to placenta previa.

The nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a healthy 5-year-old child who was delivered at 38 weeks and tells the nurse that she does not have a history of any type of abortion or fetal demise. Using GTPAL, what should the nurse document in the client's chart? 1. G = 3, T = 2, P = 0, A = 0, L = 1 2. G = 2, T = 1, P = 0, A = 0, L = 1 3. G = 1, T = 1, P = 1, A = 0, L = 1 4. G = 2, T = 0, P = 0, A = 0, L = 1

Answer: 2 Rationale: Pregnancy outcomes can be described with the acronym GTPAL. G is gravidity, the number of pregnancies; T is term births, the number born at term (longer than 37 weeks); P is preterm births, the number born before 37 weeks of gestation; A is abortions or miscarriages, the number of abortions or miscarriages (included in gravida if before 20 weeks of gestation; included in parity [number of births] if past 20 weeks of gestation); and L is the number of current living children. A woman who is pregnant with twins and has a child has a gravida of 2. Because the child was delivered at 38 weeks, the number of term births is 1, and the number of preterm births is 0. The number of abortions is 0, and the number of living children is 1.

.The nursing instructor asks the student to describe fetal circulation, specifically the ductus venosus. Which statement by the student indicates an understanding of the ductus venosus? 1. "It connects the pulmonary artery to the aorta." 2. "It is an opening between the right and left atria." 3. "It connects the umbilical vein to the inferior vena cava." 4. "It connects the umbilical artery to the inferior vena cava."

Answer: 3 Rationale: The ductus venosus connects the umbilical vein to the inferior vena cava. The foramen ovale is a temporary opening between the right and left atria. The ductus arteriosus joins the aorta and the pulmonary artery.

The nurse continues to assess a client who is in the late first stage of labor for progress and fetal well-being. At the last vaginal exam, the client was fully effaced, 8 cm dilated, vertex presentation, and station -1. Which observation would indicate that the fetus was in fetal distress? 1. The fetal heart rate slowly drops to 110 beats/min during strong contractions, recovering to 138 beats/min immediately afterward. 2. Fresh meconium is found on the examiner's gloved fingers after a vaginal exam, and the fetal monitor pattern remains essentially unchanged. 3. Fresh, thick meconium is passed with a small gush of liquid, and the fetal monitor shows late decelerations with a variable descending baseline. 4. The vaginal exam continues to reveal some old meconium staining, and the fetal monitor demonstrates a U-shaped pattern of deceleration during contractions, recovering to a baseline of 140 beats/min.

Answer: 3 Rationale: Meconium staining alone is not a sign of fetal distress. Meconium passage is a normal physiological function that is frequently noted with a fetus of more than 38 weeks' gestation. Fresh meconium in combination with late decelerations and a variable descending baseline is an ominous signal of fetal distress caused by fetal hypoxia. It is not unusual for the fetal heart rate to drop to less than the 140 to 160 beats/min range in late labor during contractions, and, in a healthy fetus, the fetal heart rate will recover between contractions. Old meconium staining may be the result of a prenatal trauma that is resolved.

A client arrives at a birthing center in active labor. After examination, it is determined that her membranes are still intact and she is at a −2 station. The primary health care provider prepares to perform an amniotomy. What will the nurse relay to the client as the most likely outcomes of the amniotomy? Select all that apply. 1. Less pressure on her cervix 2. Decreased number of contractions 3. Increased efficiency of contractions 4. The need for increased maternal blood pressure monitoring 5. The need for frequent fetal heart rate monitoring to detect the presence of a prolapsed cord

Answer: 3, 5 Rationale: Amniotomy (artificial rupture of the membranes) can be used to induce labor when the condition of the cervix is favorable (ripe) or to augment labor if the progress begins to slow. Rupturing of the membranes allows the fetal head to contact the cervix more directly and may increase the efficiency of contractions. Increased monitoring of maternal blood pressure is unnecessary after this procedure. The fetal heart rate needs to be monitored frequently, as there is an increased likelihood of a prolapsed cord with ruptured membranes and a high presenting part.

. Which purposes of placental functioning should the nurse include in a prenatal class? Select all that apply. 1. It cushions and protects the baby. 2. It maintains the temperature of the baby. 3. It is the way the baby gets food and oxygen. 4. It prevents all antibodies and viruses from passing to the baby. 5. It provides an exchange of nutrients and waste products between the mother and developing fetus.

Answer: 3, 5 Rationale: The placenta provides an exchange of oxygen, nutrients, and waste products between the mother and the fetus. The amniotic fluid surrounds, cushions, and protects the fetus and maintains the body temperature of the fetus. Nutrients, medications, antibodies, and viruses can pass through the placenta.

A maternity nurse is teaching a pregnant client about the physiological effects and hormone changes that occur in pregnancy. The client asks the nurse about the purpose of estrogen. Which information should the nurse provide to the client about estrogen? 1. It maintains the uterine lining for implantation. 2. It stimulates metabolism of glucose and converts the glucose to fat. 3. It prevents the involution of the corpus luteum and maintains the production of progesterone until the placenta is formed. 4. It stimulates uterine development to provide an environment for the fetus and stimulates the breasts to prepare for lactation

Answer: 4 Rationale: Estrogen stimulates uterine development to provide an environment for the fetus and stimulates the breasts to prepare for lactation. Progesterone maintains the uterine lining for implantation and relaxes all smooth muscle. Human placental lactogen stimulates the metabolism of glucose and converts the glucose to fat. Human chorionic gonadotropin prevents involution of the corpus luteum and maintains the production of progesterone until the placenta is formed.

The nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which is noted on the external monitor tracing during a contraction? 1. Variability 2. Accelerations 3. Early decelerations 4. Variable decelerations

Answer: 4 Rationale: Variable decelerations occur if the umbilical cord becomes compressed, reducing blood flow between the placenta and the fetus. Variability refers to fluctuations in the baseline fetal heart rate. Accelerations are a reassuring sign and usually occur with fetal movement. Early decelerations result from pressure on the fetal head during a contraction.

A 25-year-old client is admitted with the following history: 12 weeks pregnant, vaginal bleeding, no fetal heartbeat seen on ultrasound. The nurse would expect the doctor to write an order to prepare the client for which of the following? 1. Cervical cerclage. 2. Amniocentesis. 3. Nonstress testing. 4. Dilation and curettage

Dilation and curettage (D&C) is performed on a client with an incomplete abortion.

State four risk factors for or predisposing factors to postpartum hemorrhage.

Dystocia or prolonged labor, overdistention of the uterus, abruptio placentae, and infection

What condition should the nurse suspect if a woman of childbearing age presents to an emergency room with bilateral or unilateral abdominal pain, with or without bleeding?

Ectopic pregnancy

A 26-week-gestation woman is diagnosed with severe preeclampsia with HELLP syndrome. The nurse will assess for which of the following signs/symptoms? 1. Low serum creatinine. 2. High serum protein. 3. Bloody stools. 4. Epigastric pain

Epigastric pain is associated with the liver involvement of HELLP syndrome.

What is a reactive nonstress test?

FHR acceleration of 15 bpm for 15 seconds in response to fetal movement

True or False:The newborn's head is usually smaller than the chest.

False: The head is usually 2 cm larger unless severe molding occurred.

Conditions of fertilization

Fertilization takes place in ampulla (outer third) section of the fallopian tube. The zygote (fertilized ovum) takes 3 to 4 days to enter the uterus. It takes 7 to 10 days to complete the process of nidation (implantation)

What does the BPP determine?

Fetal well being

When should the postpartum dosage of oxytocin (Pitocin) be administered? Why is it administered?

Give immediately after placenta is delivered to prevent postpartum hemorrhage and atony

State one contraindication to the use of ergot drugs (Methergine).

HTN

What is the cause of preeclampsia?

However, the underlying pathophysiology appears to be generalized vasospasm with increased peripheral resistance and vascular damage. This decreased perfusion results in damage to numerous organs.

What is the danger associated with regional blocks?

Hypotension resulting from vasodilatation below the block, which pools blood in the periphery, reducing venous return

Name four causes of decreased FHR variability.

Hypoxia, acidosis, drugs, fetal sleep

What are the major symptoms of preeclampsia?

Increase in BP of 30 mm Hg systolic and 15 mm Hg diastolic over previous baseline; proteinuria (albuminuria); CNS disturbances

What factors does a nurse look for in determining a newborn's ability to take in nourishment by nipple and mouth?

Infant has good suck, has coordinated suck-swallow, takes less than 20 minutes to feed, gains 20 to 30 g/day

. Describe the maternal changes that characterize the transition phase of labor.

Irritability and unwillingness to be touched, but does not want to be left alone; nausea, vomiting, and hiccupping

Name three maternal and three fetal complications of gestational diabetes

Maternal: hypoglycemia, hyperglycemia, ketoacidosis Fetal: macrosomia, hypoglycemia at birth, fetal anomalies

May women with a positive HIV antibody try to breastfeed?

No, HIV has been found in breast milk

Must women diagnosed with mastitis stop breastfeeding?

No, women who stop breastfeeding abruptly may make the situation worse by increasing congestion and engorgement and providing further media for bacterial growth. Client may have to discontinue breastfeeding if pus is present or if antibiotics are contraindicated for neonate.

List three conditions clients with diabetes mellitus are more prone to develop

Preeclampsia, hydramnios, infection

List three symptoms of placenta previa

Previa: pain-free; bright-red vaginal bleeding; normal FHR;soft uterus

. List the three main assessment findings indicating toxic effects of magnesium sulfate.

Reduced urinary output, reduced respiratory rate, and decreased reflexes

List the risk factors for hyperbilirubinemia.

Rh incompatibility, ABO incompatibility, prematurity, sepsis, perinatal asphyxia

A woman has been diagnosed with a ruptured ectopic pregnancy. Which of the following signs/symptoms is characteristic of this diagnosis? 1. Dark brown rectal bleeding. 2. Severe nausea and vomiting. 3. Sharp unilateral pain. 4. Marked hyperthermia.

Sharp unilateral pain is a common symptom of a ruptured ectopic

What is the major side effect of beta-adrenergic tocolytic drugs (Terbutaline)?

Tachycardia

What is the most common complication of oxytocin augmentation or induction of labor? List three actions the nurse should take if such a complication occurs

Tetany.Turn off Pitocin.Turn pregnant woman onto side.Administer O2 by mask

Define cervical effacement.

The taking up of the lower cervical segment into the upper segment; the shortening of the cervix expressed in percentages from 0-100% or complete effacement

A new mother asks the nurse whether circumcision is medically indicated in the newborn. How should the nurse respond?

There is controversy concerning this issue, but we do know it causes pain and trauma to the newborn, and the medical indications (prevention of penile and cervical cancer) may be unfounded

What should the fundal height be at 3 days postpartum for a woman who has had a vaginal delivery?

Three fingerbreadths/cm below the umbilicus

Where is the FHR best heard?

Through the fetal back in vertex, OA positions

Identify the nursing plans and interventions for a woman hospitalized with hyperemesis gravidarum.

Weigh daily; check urine ketone three times daily; give progressive diet; check FHR every 8 hours; monitor for electrolyte imbalances.

When should the nurse hold the dose of magnesium sulfate and call the physician?

When the client's respirations are <12/min, DTRs are absent, or urinary output is <100 mL/4 hr

Precipitous labor is defined as?

labor that lasts 3 hours or less for the entire labor and delivery

Which data should the nurse assess on the 2-hour postpartum client who delivered vaginally? Select all that apply. 1. Palpate the client's breasts. 2. Check the client's vaginal discharge. 3. Assess the client's pedal pulses. 4. Inspect the client's surgical incision. 5. Check the client's pupillary response.

. 1 and 2 are correct. 1. The breasts should be palpated to assess for fullness or engorgement. 2. The nurse should check for the amount, color, and consistency of vaginal discharge.

A pregnant diabetic has been diagnosed with hydramnios. Which of the following would explain this finding? 1. Excessive fetal urination. 2. Recurring hypoglycemic episodes. 3. Fetal sacral agenesis. 4. Placental vascular damage.

. 1. The hydramnios is likely a result of excessive fetal urination.

The nurse in the labor room is caring for a client in the active stage of the first phase of labor. The nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. What is the most appropriate nursing action? 1. Administer oxygen via face mask. 2. Place the mother in a supine position. 3. Increase the rate of the oxytocin intravenous infusion. 4. Document the findings and continue to monitor the fetal patterns.

. Answer: 1 Rationale: Late decelerations are due to uteroplacental insufficiency and occur because of decreased blood flow and oxygen to the fetus during the uterine contractions. Hypoxemia results; oxygen at 8 to 10 L/minute via face mask is necessary. The supine position is avoided because it decreases uterine blood flow to the fetus. The client should be turned onto her side to displace pressure of the gravid uterus on the inferior vena cava. An intravenous oxytocin infusion is discontinued when a late deceleration is noted. The oxytocin would cause further hypoxemia because of increased uteroplacental insufficiency resulting from stimulation of contractions by this medication. Although the nurse would document the occurrence, option 4 would delay necessary treatment.

Which of the following vital sign changes should the nurse highlight for a pregnant woman's obstetrician? 1. Prepregnancy blood pressure (BP) 100/60 and third trimester BP 140/90. 2. Prepregnancy respiratory rate (RR) 16 rpm and third trimester RR 22 rpm. 3. Prepregnancy heart rate (HR) 76 bpm and third trimester HR 88 bpm. 4. Prepregnancy temperature (T) 98.6ºF and third trimester T 99.2ºF.

1 1. The blood pressure should not elevate during pregnancy. This change should be reported to the health care practitioner. 2. An increase in the respiratory rate is expected. 3. An increase in the heart rate is expected. 4. A slight increase in temperature is expected.

. List the factors predisposing a woman to preterm labor.

. Urinary tract infection; overdistention of uterus; diabetes; preeclampsia; cardiac disease; placenta previa, psychosocial factors such as stress

List the symptoms of hyperbilirubinemia in the neonate.

Bilirubin levels rising 5 mg/day, jaundice, dark urine, anemia, high reticulocyte (RBC) count, and dark stools

State four risk factors for or predisposing factors to postpartum infection

Operative delivery, intrauterine manipulation, anemia or poor physical health, traumatic delivery, and hemorrhage

Why are serum or amniotic AFP levels done prenatally?

To determine whether AFP levels are elevated, which may indicate the presence of neural tube defects; or whether they are low, which may indicate trisomy 21

What is the antidote for magnesium sulfate?

calcium gluconate

. The nurse is preparing a list of self-care instructions for a postpartum client who was diagnosed with mastitis. Which instructions should be included on the list? Select all that apply. 1. Wear a supportive bra. 2. Rest during the acute phase. 3. Maintain a fluid intake of at least 3000 mL/day. 4. Continue to breast-feed if the breasts are not too sore. 5. Take the prescribed antibiotics until the soreness subsides. 6. Avoid decompression of the breasts by breast-feeding or breast pump.

. Answer: 1, 2, 3, 4 Rationale: Mastitis is an inflammation of the lactating breast as a result of infection. Client instructions include resting during the acute phase, maintaining a fluid intake of at least 3000 mL/day (if not contraindicated), and taking analgesics to relieve discomfort. Antibiotics may be prescribed and are taken until the complete prescribed course is finished. They are not stopped when the soreness subsides. Additional supportive measures include the use of moist heat or ice packs and wearing a supportive bra. Continued decompression of the breast by breast-feeding or breast pump is important to empty the breast and prevent the formation of an abscess.

The nurse should make which statement to a pregnant client found to have a gynecoid pelvis? 1. "Your type of pelvis has a narrow pubic arch." 2. "Your type of pelvis is the most favorable for labor and birth." 3. "Your type of pelvis is a wide pelvis, but it has a short diameter." 4. "You will need a cesarean section because this type of pelvis is not favorable for a vaginal delivery."

. Answer: 2 Rationale: A gynecoid pelvis is a normal female pelvis and is the most favorable for successful labor and birth. An android pelvis (resembling a male pelvis) would be unfavorable for labor because of the narrow pelvic planes. An anthropoid pelvis has an outlet that is adequate, with a normal or moderately narrow pubic arch. A platypelloid pelvis (flat pelvis) has a wide transverse diameter, but the anteroposterior diameter is short, making the outlet inadequate.

. A pregnant client is receiving magnesium sulfate for the management of preeclampsia. The nurse determines that the client is experiencing toxicity from the medication if which findings are noted on assessment? Select all that apply. 1. Proteinuria of 3 + 2. Respirations of 10 breaths per minute 3. Presence of deep tendon reflexes 4. Urine output of 20 mL in an hour 5. Serum magnesium level of 4 mEq/L (2 mmol/L)

. Answer: 2, 4 Rationale: Magnesium toxicity can occur from magnesium sulfate therapy. Signs of magnesium sulfate toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression, loss of deep tendon reflexes, and a sudden decline in fetal heart rate and maternal heart rate and blood pressure. Respiratory rate below 12 breaths per minute is a sign of toxicity. Urine output should be at least 25 to 30 mL per hour. Proteinuria of 3 + is an expected finding in a client with preeclampsia. Presence of deep tendon reflexes is a normal and expected finding. Therapeutic serum levels of magnesium are 4 to 7.5 mEq/L (2 to 3.75 mmol/L)

The nurse is reviewing true and false labor signs with a multiparous client. The nurse determines that the client understands the signs of true labor if she makes which statement? 1. "I won't be in labor until my baby drops." 2. "My contractions will be felt in my abdominal area." 3. "My contractions will not be as painful if I walk around." 4. "My contractions will increase in duration and intensity."

. Answer: 4 Rationale: True labor is present when contractions increase in duration and intensity. Lightening or dropping leads to engagement (presenting part reaches the level of the ischial spine) and occurs when the fetus descends into the pelvis about 2 weeks before delivery. Contractions felt in the abdominal area and contractions that ease with walking are signs of false labor

. The nurse is performing an assessment on a client diagnosed with placenta previa. Which assessment findings should the nurse expect to note? Select all that apply. 1. Uterine rigidity 2. Uterine tenderness 3. Severe abdominal pain 4. Bright red vaginal bleeding 5. Soft, relaxed, nontender uterus 6. Fundal height may be greater than expected for gestational

. Answer: 4, 5, 6 Rationale: Placenta previa is an improperly implanted placenta in the lower uterine segment near or over the internal cervical os. Painless, bright red vaginal bleeding in the second or third trimester of pregnancy is a sign of placenta previa. The client has a soft, relaxed, nontender uterus, and fundal height may be more than expected for gestational age. In abruptio placentae, severe abdominal pain is present. Uterine tenderness accompanies placental abruption. In addition, in abruptio placentae, the abdomen feels hard and board-like on palpation, as the blood penetrates the myometrium and causes uterine irritability.

State three nursing interventions during forceps delivery

. Ensure empty bladder.Auscultate FHR before application, during process, and between traction periods. Observe for maternal lacerations and newborn cerebral or facial trauma.

State the most important action to take when a cord prolapse is determined.

. Examiner should position mother to relieve pressure on the cord or push the presenting part off the cord with fingers until emergency delivery is accomplished.

. List the symptoms of a full bladder that might occur in the fourth stage of labor

. Fundus above umbilicus, dextroverted (to the right side of abdomen), increased bleeding (uterine atony)

To promote comfort, what nursing interventions are used for a third-degree episiotomy that extends into the anal sphincter?

. Ice pack, witch hazel compresses, and no rectal manipulation

What is the danger to the newborn of heat loss in the first few hours of life?

. It leads to depletion of glucose (there is very little glycogen storage in immature liver); body begins to use brown fat for energy, producing ketones and causing subsequent ketoacidosis and shock

. Physiologic jaundice in the newborn occurs _____. It is caused by _____.

. Jaundice occurs at 2 to 3 days of life and is caused by immature liver's inability to keep up with the bilirubin production resulting from normal RBC destruction.

. State three principles relative to the pattern of weight gain in pregnancy

. Total gain should average 25 to 35 lb. Gain should be consistent throughout pregnancy.An average of 1 lb/week should be gained in the second and third trimesters.

When monitoring a fetal heart rate with moderate variability, the nurse notes V-shaped decelerations to 80 from a baseline of 120. One occurred during a contraction, another occurred 10 seconds after the contraction, and a third occurred 40 seconds after yet another contraction. The nurse interprets these findings as resulting from which of the following? 1. Metabolic acidosis. 2. Head compression. 3. Cord compression. 4. Insufficient uteroplacental blood flow

3. The contractions described in the scenario result from cord compression (variable decelerations).

. A multigravid client is 22 weeks pregnant. Which of the following symptoms would the nurse expect the client to exhibit? 1. Nausea. 2. Dyspnea. 3. Urinary frequency. 4. Leg cramping.

4 1. Nausea is commonly seen in the first trimester but should have resolved by the time the second trimester begins. 2. Dyspnea is commonly seen in the third trimester, not the second trimester. 3. Urinary frequency is commonly seen in the first trimester and late in the third trimester, but it is not related to the second trimester. 4. Leg cramping is often a complaint of clients in the second trimester.

Name the four periodic changes of the FHR, their causes, and one nursing treatment for each

Accelerations are caused by a burst of sympathetic activity; they are reassuring and require no treatment. Early decelerations are caused by head compression; they are benign and alert the nurse to monitor for labor progress and fetal descent. Variable decelerations are caused by cord compression; change of position should be tried first. Late decelerations are caused by UPI and should be treated by placing client on her side and administering oxygen.

A rubella titer result of a 1-day postpartum client is less than 1:8, and a rubella virus vaccine is prescribed to be administered before discharge. The nurse provides which information to the client about the vaccine? Select all that apply. 1. Breast-feeding needs to be stopped for 3 months. 2. Pregnancy needs to be avoided for 1 to 3 months. 3. The vaccine is administered by the subcutaneous route. 4. Exposure to immunosuppressed individuals needs to be avoided. 5. A hypersensitivity reaction can occur if the client has an allergy to eggs. 6. The area of the injection needs to be covered with a sterile gauze for 1 week.

Answer: 2, 3, 4, 5 Rationale: Rubella vaccine is administered to women who have not had rubella or women who are not serologically immune. The vaccine may be administered in the immediate postpartum period to prevent the possibility of contracting rubella in future pregnancies. The live attenuated rubella virus is not communicable in breast milk; breast-feeding does not need to be stopped. The client is counseled not to become pregnant for 1 to 3 months after immunization or as specified by the obstetrician because of a possible risk to a fetus from the live virus vaccine; the client must be using effective birth control at the time of the immunization. The client should avoid contact with immunosuppressed individuals because of their low immunity toward live viruses and because the virus is shed in the urine and other body fluids. The vaccine is administered by the subcutaneous route. A hypersensitivity reaction can occur if the client has an allergy to eggs because the vaccine is made from duck eggs. There is no useful or necessary reason for covering the area of the injection with a sterile gauze

. List three nursing interventions for the neonate undergoing phototherapy.

Apply opaque mask over eyes. Leave diaper loose so stools and urine can be monitored but cover genitalia. Turn every 2 hours. Watch for dehydration.

If meconium was passed in utero, what action must the nurse take in the delivery room?

Arrange for immediate endotracheal tube observation to determine the presence of meconium below the vocal cords (prevents pneumonitis and meconium aspiration syndrome).

When is the screening test for PKU done?

At 2 to 3 days of life, or after enough breast milk or formula, usually after 24 hours, is ingested to allow for determination of body's ability to metabolize amino acid phenylalanine

State the advantage of CVS over amniocentesis.

Can be done between 8-12 weeks gestation Results are returned within 1 week. so.... Allows for decision about termination while still in the 1st trimester

. When is preterm labor able to be arrested?

Cervix is <4 cm dilated, <50% effacement, and membranes are intact and not bulging out of the cervical os.

The nurse anticipates which newborns will be at greater risk for problems in the transitional period. State three factors that predispose to respiratory depression in the newborn.

Cesarean section delivery; magnesium sulfate given to mother in labor; asphyxia or fetal distress during labor

A woman's white blood count is 17,000;she is afebrile and has no symptoms of infection.What nursing action is indicated?

Continue routine assessments; normal leukocytosis occurs during postpartal period because of placental site healing.

What interventions should the nurse implement to prevent further CNS irritability in the preeclampsia client?

Darken room, limit visitors, maintain close 1:1 nurse-to-client ratio, place in private room, plan nursing interventions all at the same time so client is disturbed as little as possible.

. What specific information should the nurse include when teaching about HPV detection and treatment?

Detection of dry, wartlike growths on vulva or rectum. Need for Pap smear in the prenatal period. Treatment with laser ablation (cannot use podophyllin during pregnancy). Associated with cervical carcinoma in mother and respiratory papillomatosis in neonate.Teach about immunization for females age 9 to 30 with Gardasil.

What contraceptive technique is recommended for diabetic women?

Diaphragm with spermicide; clients should avoid birth control pills, which contain estrogen, and IUDs, which are an infection risk.

. A breastfeeding mother complains of very tender nipples. What nursing actions should be taken?

Have her demonstrate infant position on breast (incorrect positioning often causes tenderness). Leave bra open to air-dry nipples for 15 minutes three times daily. Express colostrum and rub on nipples.

The nurse notes a swelling over the back part of the newborn's head. Is this a normal newborn variation?

It depends on the finding. If it crosses suture lines and is a caput (edema), it is normal. If it does not cross suture lines, it is a cephalohematoma with bleeding between the skull and periosteum. This could cause hyperbilirubinemia. This is an abnormal variation

List three nursing interventions to ease the discomfort of afterpains.

Keep bladder empty. Provide a warm blanket for abdomen. Administer analgesics prescribed by health care provider

. List five signs and symptoms new parents should be taught to report immediately to a doctor or clinic.

Lethargy, temperature >100° F, vomiting, green stools,refusal of two feeds in a row

. List five prodromal signs of labor the nurse might teach the client.

Lightening, Braxton Hicks contractions, increased bloody show, loss of mucous plug, burst of energy, and nesting behaviors

What symptoms are common to most newborns with Down syndrome?

Low-set ears,simian crease on palm, protruding tongue, Brushfield spots in iris, epicanthal folds

. What are the major goals of nursing care related to pregnancy-induced hypertension with preeclampsia?

Maintenance of uteroplacental perfusion; prevention of seizures; prevention of complications such as HELLP syndrome, DIC, and abruption

. List four nursing actions for the second stage of labor.

Make sure cervix is completely dilated before pushing is allowed. Assess FHR with each contraction. Teach woman to hold breath for no longer than 10 seconds.Teach pushing technique

State three priority nursing actions in the postdelivery period for the client with preeclampsia.

Monitor for signs of blood loss. Continue to assess BP and DTRs every 4 hours. Monitor for uterine atony

All pregnant women should be taught preterm labor recognition. Describe the warning symptoms of preterm labor

More than five contractions per hour; cramps; low, dull backache; pelvic pressure; change in vaginal discharge

State two ways to determine whether the membranes have truly ruptured

Nitrazine testing: Paper turns dark blue or black Demonstration of fluid ferning under microscope

A nurse discovers a postpartum client with a boggy uterus that is displaced above and to the right of the umbilicus. What nursing action is indicated?

Perform immediate fundal massage. Ambulate to the bathroom or use bedpan to empty bladder because cardinal signs of bladder distention are present.

Describe discharge counseling for a woman after hydatidiform mole evacuation by D&C.

Prevent pregnancy for 1 year. Return to clinic or MD for monthly hCG levels for 1 year. Postoperative D&C instructions: Call if bright-red vaginal bleeding or foul-smelling vaginal discharge occurs or temperature spikes over 100.4° F.

. A woman, 8 weeks pregnant, is admitted to the obstetric unit with a diagnosis of threatened abortion. Which of the following tests would help to determine whether the woman is carrying a viable or a nonviable pregnancy? 1. Luteinizing hormone level. 2. Endometrial biopsy. 3. Hysterosalpinogram. 4. Serum progesterone level.

Serum progesterone will provide information on the viability of a pregnancy. One relatively easy way to determine the viability of the conceptus is by performing a serum progesterone test; high levels indicate a viable baby whereas low levels indicate a pregnancy loss.

Indications of ovulation

Slight drop in temperature occurs 1 day before this; spinnbarkeit (egg white stretchiness of cervical mucus) occurs; ferning is seen under microscope

A nurse is teaching a mother how to care for her 3-day-old son's circumcised penis. Which of the following actions demonstrates that the mother has learned the information? 1. The mother cleanses the glans with a cotton swab dipped in hydrogen peroxide. 2. The mother covers the glans with antifungal ointment after rinsing off any discharge. 3. The mother squeezes soapy water from the wash cloth over the glans. 4. The mother replaces the dry sterile dressing before putting on the diaper

Squeezing soapy water over the penis cleanses the area without irritating the site and causing the site to bleed.

What are the signs of endometritis?

Subinvolution (boggy, high uterus); lochia returning to rubra with possible foul smell; temperature 100.4° F or higher; unusual fundal tenderness

What maternal position provides optimum fetal and placental perfusion during pregnancy?

The knee-chest position, but the ideal position of comfort for the mother, which supports fetal, maternal, and placental perfusion, is the side-lying position (removes pressure from the abdominal vessels [vena cava, aorta]).

The client in labor is showing late decelerations on the fetal monitor. Which intervention should the nurse implement first? 1. Notify the healthcare provider (HCP) immediately. 2. Instruct the client to take slow, deep breaths. 3. Place the client in the left lateral position. 4. Prepare for an immediate delivery of the fetus.

The left lateral position will improve placental blood flow and oxygen supply to the fetus. This should be the nurse's first intervention.

The nurse instructed the unlicensed assistive personnel (UAP) to provide a sitz bath to the postpartum client with hemorrhoids. Which priority intervention should the nurse implement? 1. Document the sitz bath in the client's nurse's notes. 2. Follow-up to ensure the UAP gave the sitz bath. 3. Assess the client's hemorrhoids every 4 hours. 4. Discuss the importance of not getting constipated.

The most important intervention for the nurse to do when delegating a task is to follow up to ensure it was done.

The client is 1 day postpartum, and the nurse notes the fundus is displaced laterally to the right. Which nursing intervention should be implemented first? 1. Prepare to perform an in-and-out catheterization. 2. Assess the bladder using the bladder scanner. 3. Massage the client's fundus for 2 minutes. 4. Assist the client to the bathroom to urinate.

The number one reason for a displaced fundus is a full bladder. The nurse should always do the least invasive procedure, which is to ask the client to attempt to void. The emptying of the bladder should allow the fundus to return to the midline position.

The labor and delivery nurse performs Leopold's maneuvers. A soft round mass is felt in the fundal region. A flat object is noted on the left and small objects are noted on the right of the uterus. A hard round mass is noted above the symphysis. Which of the following positions is consistent with these findings? 1. Left occipital anterior (LOA). 2. Left sacral posterior (LSP). 3. Right mentum anterior (RMA). 4. Right sacral posterior (RSP).

The nurse's findings upon performing Leopold's maneuvers indicate that the fetus is in the left occiput anterior position (LOA)—that is, the fetal back is felt on the mother's left side, the small parts are felt on her right side, the buttocks are felt in the fundal region, and the head is felt above her symphysis

The charge nurse has received laboratory results for clients on the postpartum unit. Which client would warrant intervention by the nurse? 1. The client whose white blood cell count is 18,000 mm3. 2. The client whose serum creatinine level is 0.8 mg/dL. 3. The client whose platelet count is 410,000 mm3. 4. The client whose serum glucose level is 280 mg/dL.

This glucose level is elevated, and the nurse should investigate further as to why the glucose level is abnormal. The normal glucose level is 70 to 120 mg/dL.

What is the purpose of administering magnesium sulfate?

To prevent seizures by decreasing CNS irritability

How is true labor discriminated from false labor?

True labor: regular, rhythmic contractions that intensify with ambulation, pain in the abdomen sweeping around from the back, and cervical changes False labor: irregular rhythm, abdominal pain (not in back) that decreases with ambulation

When should a laboring client be examined vaginally?

Vaginal examinations should be done prior to analgesia and anesthesia to rule out cord prolapse, to determine labor progress if it is questioned, and to determine when pushing can begin.