OB unit 3 test questions
CMV testing methods
-Isolation of the virus in amniotic fluid or polymerase chain reaction (PCR) (rapid analysis of gene sequence for in vitro dx of infection) -most infections are asymptomatic so they may not be suspected or tested. Dx of neonatal infection is done by urine culture.
When admitting a client for induction of labor, the nurse will question the procedure if which of the following is on the client's prenatal record? a. Spontaneous rupture of membranes 24 hours ago, with no labor b.42-week gestation c. Placenta previa d.Maternal heart disease that is worsening
C. Placenta Previa -An induction of labor would be contraindicated in a woman with placenta previa. The labor would result in hemorrhaging. Options A, B, and D are all indications for induction.
A laboring woman just had an amniotomy performed to augment labor. The nurse is aware that the assessment times for which vital signs will be altered? a. Maternal blood pressure b. Maternal pulse c. Maternal temperature d. Maternal respiration
C. Temp - With interruption of the membrane barrier, vaginal organisms have free access to the uterine cavity and may cause chorioamnionitis. Assessing the maternal temperature every 2 to 4 hours will be necessary to monitor for signs of infection.
T or F seizure meds can be stopped abruptly during pregnancy
F. The women must be seizure free for a prolonged period of time and stopped at the directive of her physician . generalized seizures result fetal hypoxia and acidosis.
Select all the signs and symptoms listed that may indicate hypovolemic shock. Fetal tachycardia Maternal bradycardia Decreased blood pressure Cold and clammy skin Increased urinary output
Fetal tachycardia Correct Maternal bradycardia Decreased blood pressure Correct Cold and clammy skin Correct Increased urinary output
Select the following that assist the newborn to initiate respirations. (Select all that apply). a. Decrease in oxygen b. Decrease in carbon dioxide Incorrect c. Release of pressure on the chest at birth d. Rise in environmental temperature at birth
a. Decrease in oxygen Correct c. Release of pressure on the chest at birth Correct
Fetal hydantoin syndrome
a major concern of teratogenic effects of anticovulsant drugs. Includes craniofacial abnormalities, limb reduction defects, growth restriction, intellectual disabilities
Immediately following an amniotomy to observe for complications, the nurse must assess the: a. Fetal heart rate. b.Maternal blood pressure. c. Maternal pulse. d.Fetal variability.
a. FHR - One complication of an amniotomy is prolapse of the umbilical cord. Cord compression can be diagnosed by observing for variable decelerations or a decrease in the fetal heart rate. Maternal blood pressure, pulse, and fetal variability are all necessary to assess, but are not the immediate concerns.
When doing a newborn assessment on a 2-day-old infant, the nurse notices facial jaundice. The bilirubin level was assessed and found to be 6 mg/dL. The nurse understands that this jaundice will be classified as: a. Physiologic jaundice. b. Pathologic jaundice. c. Breastfeeding jaundice. d. True breast mild jaundice.
a. Physiologic jaundice. -With physiologic jaundice, the jaundice is not present during the first 24 hours of life. It appears on the second or third day and is considered a normal phenomenon. When jaundice is noted in the face only, the jaundice level can be estimated to be from 5 to 7 mg/dL
Which of the following are used to assist with the cervical ripening process prior to induction of labor? (Select all that apply). a. Prostaglandin Correct b.Oxytocin c.Misoprostol (Cytotec) Correct d.Laminaria tents Correct
a. Prostaglandin Correct c.Misoprostol (Cytotec) Correct d.Laminaria tents Correct
Which of the following women will have the most successful induction of labor? a. Primigravida, Bishop score of 9, fFN is positive b. Gravida 2, Bishop score of 6, fFN is positive c. Gravida 2, Bishop score of 8, fFN is negative d. Primigravida, Bishop score of 5, fFN is negative
a. a. Primigravida, Bishop score of 9, fFN is positive -The Bishop score rates the cervical readiness for labor by looking at cervical dilation, effacement, consistency, position, and fetal station. Induction is more successful if the score is greater than 8. The fFN (fetal fibronectin) is present in the vaginal secretions about 2 weeks prior to the onset of term labor.
A 5-month-pregnant woman has been diagnosed with iron deficiency anemia. The nurse evaluates the patient teaching on diet to be effective when the woman selects which of the following meals to increase her iron intake? a.)Chicken with wild rice, steamed broccoli, sliced tomatoes, a green salad, and orange juice b.)Pinto beans with cornbread and milk c.) Broiled flounder, baked sweet potatoes, green beans, and iced tea d.) Refried beans with corn tortillas, Spanish rice, green salad, and coffee
a.)Chicken with wild rice, steamed broccoli, sliced tomatoes, a green salad, and orange juice -Primary sources of iron are meat, fish, chicken, and green leafy vegetables. Foods rich in vitamin C will enhance the absorption of iron. Milk, tea, and coffee will decrease the absorption of iron
A woman is admitted with a diagnosis of missed abortion. After taking her blood pressure, the nurse notices petechiae on the woman's arm where the cuff was located. The nurse's next action should be to: a.Notify the health care provider. b.Massage the arm. c.Monitor her blood pressure closely. d.Determine her temperature.
a.One major complication of missed abortion is disseminated intravascular coagulation (DIC). This may be manifested by small areas of hemorrhaging. The health care provider needs to be notified.
Which of the newborns listed are at high risk for hypoglycemia? (Select all that apply). a. Preterm Correct b. Small-for-gestational age Correct c. Postterm Correct d. Large-for-gestational age Correct e. Average-for-gestational age f. Infants with infections Correct g.Infants with cold stress
a.Preterm Correct b.Small-for-gestational age Correct c.Postterm Correct d. Large-for-gestational age Correct f. Infants with infections Correct g.Infants with cold stress
A pregnant woman should be taught that the first sign of a threatened abortion is usually: a.Vaginal bleeding. b.Uterine cramping. c.Rupture of membranes. d.Backache.
a.The first sign of threatened abortion is vaginal bleeding, which is rather common during early pregnancy. One third of pregnant women experience bleeding in early pregnancy and up to 50% of these pregnancies end in A spontaneous abortion. The vaginal bleeding may be followed by uterine cramping and backache.
While observing a 3-hour-old newborn, the nurse counted respirations of 45 breaths/min, irregular, with one episode of periodic breathing lasting 10 seconds. The newborn had no cyanosis during this time, no retractions, and no grunting. The nurse's next action is to: a. Notify the pediatrician. b. Document the normal findings. c. Administer oxygen. d. Stimulate the newborn to cry. Incorrect
b. Document the normal findings. Correct -The normal respiratory rate of a newborn is 30 to 60 breaths/min. It is not unusual for a newborn to have periodic breathing episodes lasting 5 to 10 seconds. Apnea lasting longer than 20 seconds accompanied by cyanosis, heart rate changes, or other signs of difficult breathing is abnormal.
The postpartum woman who had a long labor induced by oxytocin is at higher risk for which complication? a. Thrombophlebitis b. Hemorrhage c. Lacerations of the vaginal area d. Altered urinary elimination Incorrect
b. Hemorrhage Prolonged use of oxytocin can produce uterine atony. This will increase the risk of hemorrhaging because the uterine muscle becomes fatigued and will not contract effectively to compress vessels at the placental site. The other choices are all complications of the postpartum period, but this mother is at no higher risk than other mothers.
Which of the following factors lead to the production of excessive amounts of bilirubin during the first week of life? (Select all that apply). a. Longer red blood cell life b. Liver immaturity Correct c. Sterile intestines Correct d. Trauma during birth Correct
b. Liver immaturity Correct c. Sterile intestines Correct d. Trauma during birth Correct
When caring for a newborn the nurse must be alert for signs of cold stress, which would include which of the following? a.) Decreased activity level b.) Increased respiratory rate c.) Hyperglycemia d.)Shivering
b.) Increased respiratory rate -Additional signs of cold stress include increased activity level, crying, basal metabolic rate (BMR), and heat production. Hypoglycemia occurs as glucose stores are depleted. Newborns are unable to shiver as a means to increase heat production; they increase their activity level instead
The nurse is assessing a newborn for gestational age. Which technique should be used when performing the scarf sign? a.Fold the lower leg against the abdomen, and straighten out the leg. Measure the angle at the popliteal space. b.Bring the arm across the body to the opposite side, and note the position of the elbow in relation to the midline. c.Pull the foot straight up alongside the body toward the ear. Note the position of the foot in relation to the head. d.Bend the hand at the wrist until the palm is as flat against the forearm as possible with gentle pressure. Measure the angle between the palm and forearm.
b.Bring the arm across the body to the opposite side, and note the position of the elbow in relation to the midline. Correct
Which of the following measures will help prevent complications from an episiotomy? a.Pain medication every 3 to 4 hours as needed b.Cold applications after birth Correct c.Warm applications after birth d.Early ambulation
b.Cold applications for the first 12 hours after birth may help prevent hematomas and edema. Pain medication helps treat, not prevent, the complication of pain. Early ambulation helps prevent other complications. Warm applications are contraindicated after birth; they may be used after 12 hours.
A woman has just been admitted to the maternity unit with a diagnosis of incomplete abortion. The physician has written the following orders: (1) NPO (2) Type and crossmatch for two units of blood. (3) Start intravenous line and run Ringer's lactate at 150 mL/hr. (4) Administer Pitocin, 10 units intramuscular. (5) Acetaminophen and codeine (Tylenol with Codeine #3), every 3 to 4 hours as needed for pain (6) Bed rest with bathroom privileges Which order should the nurse carry out first for this patient? a. Inform her of the NPO and bed rest order. b.Start the IV and draw blood to send for the type and crossmatch. c.Administer the pain medication. d.Take time to listen to the client about her feelings concerning the abortion.
b.Initial treatment of an incomplete abortion should focus on stabilizing the woman cardiovascularly. She may have lost blood or is at high risk for blood loss, so it is important to have her typed and crossmatched for replacement blood. The IV will help with fluid replacement
A shrill, high-pitched cry in a newborn may indicate: a.Hunger. b.Neurologic disorder. c.Cardiac disorder. d.No significance.
b.Neurologic disorder. Newborn cries that are shrill, high-pitched, hoarse, or catlike are abnormal. These may indicate neurologic disorders or other problems.
A woman in labor has a long history of uncontrolled hypertension. The hypertension has continued throughout the pregnancy and labor. The nurse is aware that the woman is at high risk for which complication? a. Placenta previa b.Abruptio placentae c.Hypotonic contractions d.DIC
b.Risk factors for abruptio placentae include maternal hypertension. Vasoconstriction is an effect of hypertension that can affect the endometrial arteries
A 20-week-pregnant client attending her first prenatal visit tells the nurse at the maternity clinic that she has had vaginal bleeding and excessive nausea and vomiting for the past 3 days. The nurse assesses her blood pressure at 142/95 mm Hg, pulse 86 bpm, respirations 16 breaths/min. When the nurse helps the client onto the examining table, the abdomen looks larger than normal for a 20-week pregnancy. The nurse is aware that these are signs of: a.Ectopic pregnancy. b.Hydatidiform mole. c.Hyperemesis gravidarum. d.Preeclampsia.
b.Signs and symptoms of a hydatidiform mole pregnancy include a uterus that is larger than expected, vaginal bleeding, excessive nausea and vomiting, and early development of preeclampsia
A 32-week-pregnant woman calls the prenatal clinic complaining of bleeding without pain or contractions. The nurse should: a. Tell her to rest for a couple of hours and call back if it does not stop. b.Tell her to go to the hospital to be evaluated. c.Make her an appointment for the next morning. d.Have her assess fetal movement for 30 minutes.
b.Signs of placenta previa are painless bleeding after 20 weeks of gestation. Active bleeding can occur; therefore she needs to be evaluated
Throughout the assessment, the nurse must be alert for signs of respiratory distress. Select all of the following that are signs of respiratory distress. a. Respiratory rate of 55 breaths/min Incorrect b.Substernal retractions c. Nasal constriction d.Cyanosis of the hands and feet e. Grunting f. Seesaw respirations
b.Substernal retractions Correct e. Grunting Correct f. Seesaw respirations
A woman is receiving oxytocin for labor induction. The nurse notices the woman is having contractions every 2 minutes lasting for 100 seconds. The fetal heart rate is 120 to 130 bpm, with moderate variability. The nurse's next action should be to: a. Continue to monitor. b. Notify the physician. c. Turn off the oxytocin. d. Turn the oxytocin up to a stronger level.
c. Turn off the oxytocin. -The uterine resting tone should have at least 30 seconds between contractions. This woman has a resting time of 20 seconds. The fetal heart rate and variability show no compromise at this time; however, hypertonus contractions can lead to decreased fetal oxygenation. The physician may need to be notified, but after corrective actions have been taken.
A new mother is bottle-feeding her newborn for the first time. The mother expresses concern to the nurse that the newborn is only drinking ½ ounce. The nurse can best answer the mother's concerns by stating: a.) "Don't worry; the baby will drink more when he gets hungry." Incorrect b.) "Yes, he should be drinking more; let me try to feed him." c.)"His stomach just holds about ½ ounce right now. By the end of the week it will have expanded and he will be drinking more." d.) "Babies don't drink much at the first feeding, they are tired."
c.)"His stomach just holds about ½ ounce right now. By the end of the week it will have expanded and he will be drinking more." -At birth the stomach capacity of a newborn is about 6 mL but will expand to about 90 mL within the first week.
During the first prenatal clinic visit, an enzyme-linked immunosorbent assay (ELISA) for rubella immunity was done in a woman who is 2 months pregnant. The results of the test were 6 international units/mL. During the next visit, the nurse should: a.)Administer the rubella vaccine. b.)Advise the woman that she is immune. c.)Advise the woman to avoid anyone who may have rubella while she is pregnant. d.)Advise the woman to receive the vaccine during the last trimester of the pregnancy.
c.)Advise the woman to avoid anyone who may have rubella while she is pregnant. -A level of less than 8 international units/mL indicates that a person has no immunity to rubella. Pregnant women who are not immune should not receive the vaccine until the postpartum period. The vaccine poses a risk to the fetus, so it is contraindicated during pregnancy. This woman should be advised not to be exposed to the virus because the rubella virus can cross the placental barrier and infect the fetus at any time during the pregnancy.
Signs of a threatened abortion are noted in a woman at 8 weeks of gestation. Which of the following is an appropriate management approach for this type of abortion? a.Prepare the woman for a dilation and curettage (D&C). b. Place the woman on bed rest for at least 1 week and reevaluate. c.Prepare the woman for an ultrasound to determine the integrity of the gestational sac. d.Comfort the woman by telling her that if she loses this baby, she can try to get pregnant again in about 1 month.
c.A D&C is not considered until signs of progress to inevitable abortion are noted or the contents expelled are incomplete. Bed rest is not recommended for this woman, just a decrease in activities. Telling the woman she can get pregnant again soon is not a therapeutic response because it discounts the importance of this pregnancy. If the pregnancy is lost, she should be guided through the grieving process.
Which of the following would be an indication for a cesarean birth? (Select all that apply). a. Maternal coagulation defects b. Fetal death c. Cephalopelvic disproportion d. Active genital herpes e. Persistent nonreassuring FHR patters
c.Cephalopelvic disproportion Correct d.Active genital herpes Correct e.Persistent nonreassuring FHR patters Correct
A woman has just had a spontaneous abortion. She asks the nurse, "Why did this happen?" The nurse is aware that the most common cause of spontaneous abortion is: a. Improper maternal nutrition. b.Caffeine use in the early pregnancy. c.Severe congenital abnormalities. d.Improper implantation.
c.Chromosomal abnormalities account for about 50% to 60% of early spontaneous abortions. Other possible causes are various types of infections and maternal disorders.
A pregnant woman at 14 weeks of gestation is admitted to the hospital with a diagnosis of hyperemesis gravidarum. The primary goal of her treatment at this time would be to: a.Rest the gastrointestinal tract by restricting all oral intake for 48 hours. b.Reduce emotional stress by encouraging the woman to discuss her feelings. c.Reverse fluid, electrolyte, and acid-base imbalances that are present. d.Restore the woman's ability to take and retain oral fluid and foods.
c.Fluid, electrolyte, and acid-base imbalances present the greatest immediate danger to the well-being of the maternal-fetal unit. Options A, B, and D are all components of treatment but do not represent immediate care for patients with hyperemesis gravidarum
During labor, a woman suddenly complains of increasing pain, and the electronic monitor shows no uterine activity. The abdomen is boardlike and tender and the fetal heart tones show late decelerations. The nurse should: a.Turn the mother to her side and continue to monitor the fetal heart rate. b. Assess the mother's blood pressure, temperature, pulse, and respirations. c.Notify the health care provider. d.Anticipate that the woman has moved into the second stage of labor.
c.With abruptio placentae, the uterus may become exceedingly firm and tender. Because of decreased blood flow, the fetus will show signs of hypoxia. An immediate cesarean birth may be necessary; therefore the health care provider should be notified.
Before excretion of bilirubin can occur, it must be changed by the liver to a water-soluble form. This process is called ________________.
conjugation
An abortion is usually ________________ when the membranes rupture and the cervix dilates.
inevitable
If enough unconjugated bilirubin accumulates in the blood, it may cause staining of the tissues in the brain, resulting in __________________.
kernicterus
The ruddy, reddish color of the newborn skin caused by polycythemia is called _________________.
plethora
When the mother strokes the side of a newborn's mouth, the newborn will turn the head to the side touched. This reflex is called ______________.
rooting
Tx for Bell's palsy
steroids, eye patch, facial massage
