OB study guide exam 2
A nurse is providing discharge teaching to a client following the removal of a hydatidiform mole. Which of the following statements should the nurse include in the teaching? A. "Do not become pregnant for at least 1 year." B. "Seek genetic counseling for yourself and your partner prior to getting pregnant again." C. "You should have an hCG level drawn in 6 weeks." D. "Have your blood pressure checked weekly for the next month."
A. "Do not become pregnant for at least 1 year." Hydatidiform moles are uncontrolled growths in the uterus arising from placental or fetal tissue in early pregnancy. There is an increased incidence of choriocarcinoma associated with molar pregnancies. Pregnancy must be avoided for 1 year so the client can be closely monitored for manifestations of this condition.
A nurse is teaching a client about squatting exercises during pregnancy. Which of the following statements should the nurse include? A. "These exercises should be done for 15 minutes each day to strengthen the perineal muscles." B. "Squatting exercises can tone your abdomen, helping you lose weight faster following delivery." C. "Practicing squatting exercises during pregnancy will reduce lower back pain during labor." D. "Doing squatting exercises 3 times per week will improve your overall fitness."
A. "These exercises should be done for 15 minutes each day to strengthen the perineal muscles." Squatting exercises help stretch the perineum, allowing stretching during delivery and improving functional efficiency after delivery.
A nurse is caring for 4 newborns. Which of the following newborns is at the greatest risk of hypoglycemia? A. A newborn who is large for gestational age B. A newborn who has an Rh incompatibility C. A newborn who has pathologic jaundice D. A newborn who has fetal alcohol syndrome
A. A newborn who is large for gestational age Large for gestational age (LGA) newborns have a weight at or above the 90th percentile. One of the most common etiologies of LGA newborns is a mother who is diabetic. LGA newborns, especially those born to mothers who have diabetes, are at an increased risk of hypoglycemia. Other newborns at risk of hypoglycemia are small for gestational age (SGA) newborns (those below the 10th percentile), premature newborns, and newborns who have perinatal hypoxia.
A nurse is caring for a client during her first prenatal visit and notes that she is lactose-intolerant. Which of the following foods should the nurse include on a list of calcium sources for this client? A. Collard greens B. Cottage cheese C. Orange juice D. Broccoli
A. Collard greens Collard greens are a good source of lactose-free calcium. One cup of collard greens provides approximately the same amount of calcium as the equivalent volume of 240 mL (8 oz) of milk. Collard greens also contain folic acid, which is a nutrient women should consume during pregnancy to prevent birth defects.
A nurse is discussing contraceptive choices with a client who has a history of thrombophlebitis. Which of the following methods of contraception should the nurse recommend? A. Copper intrauterine device B. Combination pill C. Vaginal ring D. Medroxyprogesterone injection
A. Copper intrauterine device A history of thrombophlebitis is a contraindication for the use of hormonal contraceptive methods such as oral combinations of estrogen and progesterone in pill form, vaginal inserts that release hormones continuously, and injectable progestins. A copper intrauterine device that does not contain hormones is a safer choice for this client. Other options for this client include barrier methods and spermicides.
A nurse is reviewing risk factors for postpartum depression with a newly licensed nurse. Which of the following risk factors should the nurse include? A. Gestational diabetes B. Planned pregnancy C. Being married D. Post-term birth
A. Gestational diabetes Gestational diabetes increases the risk of postpartum depression. Other risk factors include infertility treatment, pregnancy complications, preterm birth, and a history of mood disorder.
A nurse is caring for a client who is 8 hr postpartum and is experiencing hemorrhage. Which of the following actions should the nurse implement after notifying the provider? (Select all that apply.) A. Massage the fundus B. Give oxygen at 2 L/min via nasal cannula C. Administer oxytocin with IV fluids D. Insert an indwelling urinary catheter E. Place the client in a lateral position with her legs elevated 30°
A. Massage the fundus C. Administer oxytocin with IV fluids D. Insert an indwelling urinary catheter E. Place the client in a lateral position with her legs elevated 30°
A nurse is assessing a client who has placenta previa. Which of the following findings should the nurse expect? A. Painless, bright red bleeding B. Board-like uterus C. Persistent uterine contractions D. Abdominal pain
A. Painless, bright red bleeding Placenta previa is the placement of the placenta low in the uterus. Depending on the severity, manifestations include bright red vaginal bleeding and a fundal height higher than expected for the gestational age. The presenting part is higher due to the placenta taking up space inside the lower part of the uterus.
A nurse is teaching a client who is at 8 weeks gestation and has a uterine fibroid about potential effects of the fibroid during pregnancy. Which of the following pieces of information should the nurse include? A. "The fibroid will shrink during the pregnancy." B. "The fibroid can increase the risk of postpartum hemorrhage." C. "You will receive an injection of medroxyprogesterone acetate to shrink the fibroid." D. "You will have to undergo a cesarean birth because of the fibroid."
B. "The fibroid can increase the risk of postpartum hemorrhage." Uterine fibroids can increase the risk of postpartum hemorrhage due to the increased blood supply to the uterus, which supports the fibroid.
A nurse is performing a nonstress test (NST) on a client who is at 41 weeks of gestation. The client asks what the purpose of the test is. Which of the following responses should the nurse provide? A. "This test will determine if you are likely to deliver within the next week." B. "This test will help determine if your baby is healthy." C. "This test can see how your baby responds when you have contractions." D. "This test will determine if your baby's lungs are mature."
B. "This test will help determine if your baby is healthy." This NST is used as a prenatal fetal assessment. It tracks fetal heart rate patterns expected with fetal movement and can help identify fetal distress.
A nurse is providing education to a client who is at 34 weeks of gestation about a non-stress test (NST). Which of the following pieces of information should the nurse include? A. "It will take about 10 minutes to complete the test." B. "You might have to drink orange juice during the test." C. "During the test, you will be asked to massage your nipples." D. "During the test, you will receive a medication to relax your uterus."
B. "You might have to drink orange juice during the test." An NST monitors for accelerations of the fetal heart rate over a 20-minute period. During this time, the fetus can be asleep and experience hypoactivity. The parent might be asked to drink orange juice during testing to stimulate fetal movements.
A nurse is caring for several clients. Which of the following clients should the nurse identify as a candidate for oral contraceptives? A. A client who smokes 2 packs of cigarettes per week B. A client who is breastfeeding a 7-month-old infant C. A client who is taking an anticonvulsant medication D. A client who is taking anti-HIV protease inhibitors
B. A client who is breastfeeding a 7-month-old infant A client can begin using oral contraceptives 4 weeks after childbirth; therefore, this client is a candidate for oral contraceptive therapy.
A nurse is assessing a client who is at 36 weeks of gestation. Which of the following manifestations should the nurse recognize as a potential prenatal complication and report to the provider? A. Varicose veins B. Double vision C. Leukorrhea D. Flatulence
B. Double vision Double vision, blurred vision, or visual disturbances are signs of potential complications associated with preeclampsia. The nurse should report this finding to the provider.
A nurse is teaching a client with pre-eclampsia who is scheduled to receive magnesium sulfate via continuous IV infusion about expected adverse effects. Which of the following adverse effects should the nurse include in the teaching? A. Elevated blood pressure B. Feeling of warmth C. Hyperactivity D. Generalized pruritus
B. Feeling of warmth The nurse should tell the client to expect a feeling of warmth all over her body while the magnesium sulfate is infusing.
A nurse is assisting with an amniocentesis for a client who is Rh-negative. Which of the following actions should the nurse take following the procedure? A. Send a sample of amniotic fluid to the laboratory to screen the client for chlamydia B. Send a sample of amniotic fluid to the laboratory to test for an elevated Rh-negative titer C. Administer immune globulin to the client to prevent fetal isoimmunization D. Administer intravenous antibiotics to prevent an infection
C. Administer immune globulin to the client to prevent fetal isoimmunization Because the client is Rh-negative, Rh immune globulin is administered after the procedure to prevent fetal isoimmunization or help ensure maternal antibodies will not form against any placental red blood cells that might have accidentally been released into the maternal bloodstream during the procedure.
A nurse is teaching a client during the client's first prenatal visit. Which of the following instructions should the nurse include? A. "A fetal stethoscope can first detect your baby's heart rate at 22 weeks." B. "After week 16, we can see if your baby is a boy or a girl." C. "A Doppler device can detect your baby's heart rate at 12 weeks." D. "You will first feel the baby move at about 8 weeks."
C. "A Doppler device can detect your baby's heart rate at 12 weeks." The nurse should be able to detect the fetal heartbeat with a Doppler device toward the end of the first trimester, often as early as 10 weeks of gestation.
A nurse is providing education about continuous heparin therapy for a client who is 18 hours postpartum and has developed a deep vein thrombosis (DVT). Which of the following statements should the nurse include in the teaching? A. "An adverse effect of this medication is drowsiness." B. "This medication will require frequent monitoring of WBC levels." C. "Use a soft toothbrush to brush your teeth gently." D. "Avoid taking acetaminophen while receiving this medication."
C. "Use a soft toothbrush to brush your teeth gently." An adverse effect of heparin therapy is an increased risk of bleeding. The client should use a soft toothbrush to prevent trauma and bleeding.
A nurse is assessing a newborn 1 min after birth and notes a heart rate of 136/min and respiratory rate of 36/min. The newborn has well-flexed extremities, responds to stimuli with a cry, and has blue hands and feet. Which Apgar score should the nurse assign to the newborn? A. 7 B. 8 C. 9 D. 10
C. 9 The nurse should use the Apgar scoring system to perform a quick assessment of the newborn at 1 minutes and 5 minutes after birth. The nurse should assign a score of 0, 1, or 2 to each of 5 categories. The nurse should assign a score of 2 for a heart rate >100/min; a score of 2 for a good, strong cry, which shows normal respiratory effort; a score of 2 for well-flexed extremities, which shows normal muscle tone; a score of 2 for responding to stimulation with a cry, cough, or sneeze; and a score of 1 for blue hands and feet, which is known as acrocyanosis.
A nurse is providing teaching about the selection of commercial formula to the guardian of a newborn. Which of the following pieces of information should the nurse include? A. Soy-based formula is recommended to decrease colic. B. Amino acid formula is recommended to increase the newborn's protein intake. C. Cow's milk-based formula is recommended for healthy newborns. D. Low-iron formula is recommended to prevent excess iron intake
C. Cow's milk-based formula is recommended for healthy newborns. The nurse should identify that cow's milk-based formulas are similar to human breast milk and are recommended for newborns and infants unless prescribed otherwise by the provider. Certain conditions that might indicate a need to switch to an alternate formula include galactosemia, a congenital lactase deficiency, and immunoglobulin E allergies
A nurse is assessing a newborn. Which of the following findings should the nurse report to the provider? A. Respiratory rate 52/min B. Weight 2500 grams (5.5 lb) C. Head circumference 28 cm (11 in) D. Blood glucose 48 mg/dL
C. Head circumference 28 cm (11 in) A head circumference of 28 cm (known as microcephaly) is below the expected reference range of 32 to 36.8 cm for a newborn. Microcephaly can indicate fused cranial sutures or prenatal infection with rubella, toxoplasmosis, or cytomegalovirus. The nurse should report this finding to the provider.
A nurse is caring for a client who is scheduled to receive intravenous oxytocin for the induction of labor. The client has a Bishop score of 10. Which of the following findings should the nurse expect? A. The client will require dinoprostone for ripening of the cervix. B. The client will experience lower back pain during labor. C. The client will experience a successful induction of labor. D. The client will require a vacuum- or forceps-assisted delivery.
C. The client will experience a successful induction of labor. The Bishop score indicates cervical favorability for labor inducibility by assessing cervical dilation, effacement, station, consistency, and position. A score of 8 or more favors a successful induction.
A nurse is assessing a client at 35 weeks gestation who is receiving magnesium sulfate via continuous IV infusion for severe pre-eclampsia. Which of the following findings should the nurse report to the provider? A. Deep tendon reflexes 2+ B. Blood pressure 150/96 mmHg C. Urinary output 20 mL/hr D. Respiratory rate 16/min
C. Urinary output 20 mL/hr The nurse should report a urinary output of 20 mL/hr because this can indicate inadequate renal perfusion, increasing the risk of magnesium sulfate toxicity. A decrease in urinary output can also indicate reduced renal perfusion secondary to a worsening of the client's pre-eclampsia.
A nurse is providing teaching about the rubella immunization to a client who is 24 hours postpartum. Which of the following client statements indicates an understanding of the teaching? A. "I should not breastfeed for at least 3 days after receiving this immunization." B. "I will need a second rubella booster when I see my midwife at 6 weeks postpartum." C. "I should be careful to avoid becoming pregnant within the next month." D. "This vaccine will be given into my arm muscle."
C. "I should be careful to avoid becoming pregnant within the next month."
A nurse is teaching a client who is postpartum and breastfeeding. Which of the following statements should the nurse include? A. "You will need to wait 3 months before resuming sexual intercourse." B. "You don't need to use contraception until you are 4 months postpartum." C. "As long as you breastfeed, you will experience an overproduction of vaginal lubrication." D. "A reduction in sexual interest could indicate postpartum depression."
D. "A reduction in sexual interest could indicate postpartum depression." Manifestations of postpartum depression include decreased libido, feelings of sadness or anxiety, difficulty sleeping, or loss of appetite.
A nurse is teaching a female client about nutrition during pregnancy. Which of the following instructions should the nurse include in the teaching? A. "Plan to double your normal caloric intake during the last trimester of pregnancy." B. "Expect to gain 10 to 15 lb during pregnancy." C. "Restrict your intake of sodium throughout pregnancy." D. "Do not eat swordfish, shark, or king mackerel while you are pregnant."
D. "Do not eat swordfish, shark, or king mackerel while you are pregnant." These fish have high levels of mercury, which can harm the developing nervous system of the fetus. Consumption should be avoided prior to conception and until the cessation of breastfeeding.
A nurse is providing teaching about exercise to a client who is pregnant. Which of the following pieces of information should the nurse include? A. "You can continue participating in whatever sports or activities you did prior to becoming pregnant." B. "Intermittent exercise is a great way to stay healthy during pregnancy." C. "You should limit your exercise to walking if you did not exercise prior to becoming pregnant." D. "Vigorous exercises should be limited and should not be performed in hot, humid weather."
D. "Vigorous exercises should be limited and should not be performed in hot, humid weather." Vigorous or strenuous activities should be limited to no longer than 20 minutes. Hot, humid weather and vigorous exercise can prompt dehydration or cause the fetus to develop hyperthermia.
A nurse is assessing a female client 24 hr after delivery and notes the fundus is 2 cm above the umbilicus. Which of the following actions should the nurse take? A. Administer a tocolytic medication B. Apply a heating pad to the mid-abdominal area C. Reassess the fundus in 2 hr D. Ambulate the client to the bathroom
D. Ambulate the client to the bathroom An increased fundal height in the postpartum period is a sign of a non-contracted uterus, which increases the risk for hemorrhage. The most common postpartum cause of an elevated fundal height is an over-distended bladder.
A nurse is counseling a female client who expresses a desire to conceive in the near future. Which of the following dietary recommendations should the nurse make to prevent neural tube defects? A. Take a multivitamin every day B. Decrease consumption of mercury-containing fish C. Increase consumption of dairy products D. Begin taking a folic acid supplement
D. Begin taking a folic acid supplement Adequate amounts of folic acid are necessary for fetal neural tube development. All women of child-bearing age and intention should take a folic acid supplement of 0.4 mg.
A nurse is caring for a client who is at 39 weeks gestation and shows manifestations of labor. Which of the following findings will alert the nurse that the client is in true labor? A. Contractions felt in the upper abdomen B. A small amount of bloody discharge C. Contractions occurring every 2 to 10 min D. Changes in cervical dilation or effacement
D. Changes in cervical dilation or effacement Cervical changes are signs of true labor.
A nurse is preparing to provide umbilical cord care for a newborn 12 hours after delivery. Upon inspection, the nurse notes moderate bleeding from a blood vessel. Which of the following actions should the nurse take? A. Check the newborn's heart rate B. Place a pressure dressing on the cord stump C. Administer vitamin K D. Check the integrity of the cord clamp
D. Check the integrity of the cord clamp The nurse should apply the clamp to the umbilical cord while detaching it from the placenta to stop blood flow from the cord to the placenta. When the placenta is no longer attached, the blood vessels in the cord will atrophy as the cord stump dries and shrivels. If blood is coming from a vessel prior to the cord stump necrotizing, the nurse should ensure the cord clamp has not loosened or opened. If it has, the nurse should apply a new clamp immediately.
A client who is pregnant tells the nurse that she is financially unable to buy the food and vitamins recommended during pregnancy. Which of the following actions should the nurse take? A. Explain to the client that improper nutrition could lead to birth defects in her baby. B. Instruct the client to return to the clinic for weekly weigh-ins for the remainder of the pregnancy. C. Provide the client with sample menus to promote nutritious meal preparation. D. Refer the client to a community resource that could assist with providing nutrition.
D. Refer the client to a community resource that could assist with providing nutrition. Federal and state programs are available to provide financial assistance that allows pregnant women and families with young children to purchase nutritious foods.
A nurse is caring for a client who is in labor and has fetal heart tracings of variable decelerations. Which of the following actions should the nurse take? A. Request a prescription for oxytocin B. Administer oxygen at 2 L/min via nasal cannula C. Prepare for the insertion of an intrauterine balloon D. Reposition the client from side to side
D. Reposition the client from side to side Variable decelerations are caused by cord compression. Changing the client from side to side or assisting her into a knee-chest position might relieve cord compression and improve the variable decelerations.
A nurse is assessing a client who is at 12 weeks gestation and has a hydatidiform mole. Which of the following findings should the nurse expect? A. Hypothermia B. Dark brown vaginal discharge C. Decreased urinary output D. Fetal heart tones
Dark brown vaginal discharge A hydatidiform mole (a molar pregnancy) is a benign proliferative growth of the chorionic villi that gives rise to multiple cysts. The products of conception transform into a large number of edematous, fluid-filled vesicles. As cells slough off the uterine wall, vaginal discharge is usually dark brown and can contain grape-like clusters.
Calculate APGAR score
- The nurse should assign a score of 2 to a newborn whose heart rate is above 100/min. -. The nurse should assign a score of 0 to a newborn whose muscle tone is flaccid. - The nurse should assign a score of 0 to a newborn who does not respond to stimuli.
Rh negative mothers/
. A newborn who is Rh-positive and born to a mother who is Rh-negative will have jaundice as a result of hyperbilirubinemia and the breakdown of RBCs. This is also called erythroblastosis fetalis.
A nurse is caring for a newly admitted newborn who is large for gestational age. After 30 min, the newborn becomes jittery and lethargic with hypotonic muscles and a cry that is different from the time of admission. Which of the following actions should the nurse take? A. Perform a heel stick to check the newborn's glucose level B. Obtain a prescription for serum substance screening C. Provide a feeding of sterile water D. Screen the newborn for phenylketonuria (PKU)
A. Perform a heel stick to check the newborn's glucose level A newborn who is large for gestational age is at risk of hypoglycemia. The nurse should monitor the newborn for manifestations of this condition such as jitteriness, lethargy, hypotonia, an unusual cry, respiratory distress, poor feeding, and an unstable body temperature. Based on these manifestations, the nurse should perform a heel stick to check the newborn's serum glucose level and then implement interventions to correct hypoglycemia if present.
A nurse is caring for a newborn whose mother received magnesium sulfate to treat preterm labor. Which of the following clinical manifestations in the newborn indicates toxicity due to the magnesium sulfate therapy? A. Respiratory depression B. Hypothermia C. Hypoglycemia D. Jaundice
A. Respiratory depression Magnesium sulfate can cause respiratory and neuromuscular depression in the newborn. The nurse should monitor the newborn for clinical manifestations of respiratory depression.
A nurse is caring for a client at 34 weeks gestation who presents with vaginal bleeding. Which of the following assessments will indicate whether the bleeding is caused by placenta previa or an abruptio placenta? A. Uterine tone B. Fetal heart rate C. Blood pressure D. Amount of bleeding
A. Uterine tone The uterus will be relaxed, soft, and painless if the bleeding is caused by placenta previa. With abruptio placenta, the uterus will be firm and board-like, and the client will complain of pain.
A nurse is caring for a term newborn 90 minutes after a scheduled cesarean birth. The newborn's 1-minute Apgar score was 9. The newborn's heart rate is 120/min, and his respiratory rate is 70/min. There are no indications of retractions, grunting, or nasal flaring. Which of the following actions should the nurse take? A. Request a prescription for continuous positive airway pressure (CPAP) B. Initiate close observation of the newborn for indications of respiratory distress C. Consult a respiratory therapist for chest physiotherapy D. Request an order for nitric oxide therapy
B. Initiate close observation of the newborn for indications of respiratory distress The newborn has manifestations of transient tachypnea of the newborn (TTN). This condition is thought to be a result of an incomplete clearance of fluid from the lungs at birth. Newborns born by cesarean are more likely to have TTN because the thoracic cavity is not compressed as in a vaginal birth. It usually resolves spontaneously, and close observation of the newborn is indicated.
A nurse is caring for a client who is 2 hr postpartum. The nurse notes the client's perineal pad has a large amount of lochia rubra with several clots. Which of the following actions should the nurse perform first? A. Check for a full bladder B. Massage the fundus C. Measure vital signs D. Administer carboprost IM
B. Massage the fundus The nurse should apply the safety and risk-reduction priority-setting framework, which assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The primary cause of early postpartum bleeding is uterine atony, which is manifested by a relaxed, boggy uterus. Thus, the greatest risk for this client is hemorrhage. The nurse should massage the client's fundus first. The nurse should use Maslow's hierarchy of needs, the ABC priority-setting framework, and/or nursing knowledge to identify which risk poses the greatest threat to the client.
A nurse is caring for a client who requests an intrauterine device (IUD) for contraception. Which of the following findings is a contraindication for this device? A. Hypertension B. Menorrhagia C. History of multiple gestations D. History of thromboembolic disease
B. Menorrhagia An IUD is a small plastic or copper device placed inside the uterus that changes the uterine environment to prevent pregnancy. An IUD is contraindicated for women who have menorrhagia, severe dysmenorrhea, or a history of ectopic pregnancy
A nurse is determining an Apgar score for a newborn who was born 1 minute ago. For which of the following findings should the nurse assign a score of 1? A. Heart rate 116/min B. Weak cry C. Flaccid muscles D. No response to stimuli
B. Weak cry The nurse should assign a score of 1 to a newborn who has a slow, weak cry