Elsevier Exam 2 OB EAQs

Neonates have difficulty maintaining their body temperature; however, their bodies have several mechanisms to help them do so. Which ones should a nurse remember when caring for the newborn? Select all that apply.

Flexed fetal position Brown fat metabolism Peripheral vasoconstriction

A nurse is caring for a postpartum client. Where does the nurse expect the fundus to be located if involution is progressing as expected 12 hours after birth?

1 cm above the umbilicus

One minute after birth a nurse assesses a newborn and auscultates a heart rate of 90 beats/min. The newborn has a strong, loud cry, moves all extremities well, and has acrocyanosis but is otherwise pink. What is this neonate's Apgar score

8

Which intervention would reduce the risk of perinatal transmission via vaginal birth in an adolescent who is diagnosed with HIV infection?

Using antiretroviral during the intrapartum period

A client is admitted to the labor and delivery unit for labor augmentation with oxytocin. She is postterm at 40 weeks, 3 days, and has gestational diabetes. The cervix is dilated to 2 cm and 90% effaced. The primary healthcare provider performed an amniotomy to permit internal electronic fetal monitoring. The amniotic fluid is pale yellow and moderate in amount. Immediately after the amniotomy the nurse will assess the fetal heart rate for at least 1 full minute for signs of what?

Uterine cord prolapse

What are the medical concerns in adolescent pregnancies? Select all that apply.

Anemia Poor maternal weight gain Pregnancy-induced hypertension

A client who is formula feeding her infant complains of discomfort from engorged breasts. What should the nurse recommend that the client do?

Apply cold packs and a snugly fitting bra.

The nurse is caring for a postpartum client who has chosen formula feeding. What should the nurse teach her regarding minimizing breast discomfort?

Apply covered ice packs to the breasts.

Which questions should be asked by the nurse of an adolescent client before a pregnancy test is performed? Select all that apply.

"Are you sexually active?" "When was your last period?" "Are you having any nausea?"

A nurse teaches a postpartum client how to care for her episiotomy at home. Which statement indicates to the nurse that the client understands the priority instruction?

"I need to continue perineal care after I go to the bathroom until everything is healed."

A new mother is concerned that her 1-month-old infant is nursing every 2 hours. Which response by the nurse is most appropriate?

"It's common for newborns to nurse this often. Let's talk about how you're adjusting with the new baby."

A pregnant client has a positive group B Streptococcus (GBS) test at 36 weeks' gestation. What is the priority instruction that the nurse will include in the client's teaching plan?

"This information will be in your prenatal record; however, please remind your labor and delivery nurse of this finding."

The nurse is performing a gestational age assessment using the New Ballard Scale. The infant's total neuromuscular score is 16, and total physical maturity score is 20. According to the graph, at how many weeks' gestation is the newborn? Record your answer using a whole number.

38 weeks

Although a client in labor is prepared and plans to participate in the labor and birth process, she states that she is in severe discomfort. The nurse administers the prescribed butorphanol. Which phase of labor is the safest time for the nurse to administer this medication?

Active phase

A 24-year-old client is admitted at 40 weeks' gestation. The cervix is dilated 5 cm and is 100% effaced, and the presenting part is at station 0. The nurse assesses that the fetal heart tones are just above the umbilicus. Which fetal presentation does the nurse document?

Breech

The nurse in the birthing unit assesses a primigravida who is at 42 weeks' gestation. Fluid is leaking from her vagina, and she is complaining of back pain. Which conclusion is supported by the data that the nurse has collected? -Fetus experiencing early decelerations, presenting part floating, FHR 140bpm in the right lower quadrant -Cervix 2cm dilated, 70% effaced, streaks of blood from vagina, fetal back in right lower quadrant, contractions every 3-4 minutes lasting 30-45 seconds -Positive nitrazine test

Cesarean birth is anticipated.

A new mother asks a nurse why medicine is being put in her baby's eyes. What infection should the nurse tell the mother it is given to prevent?

Chlamydia

While assessing a neonate's temperature, the nurse observes a drop in the body temperature. What is the most appropriate reason for this temperature drop?

Decreased nonshivering thermogenesis

A newborn weighing 9 lb 14 oz (4479 g) is delivered by cesarean due to cephalopelvic disproportion. The Apgar scores are 7 at 1 minute and 9 at 5 minutes. Which nursing action should be taken after the initial physical assessment?

Determine the blood glucose level

What is the nurse's priority assessment for a client in the fourth stage of labor?

Distention of the bladder

What are the major complications noticed in adolescent girls during pregnancy? Select all that apply.

Ectopic pregnancy Spontaneous abortion

What is the primary responsibility of a nurse teaching the pregnant adolescent?

Encouraging her to continue regularly scheduled prenatal care

What should supportive nursing care at the beginning of the mother-infant relationship include?

Encouraging the mother to help out with simple aspects of her newborn's care

The nurse is providing care to a multiparous client in active labor. The client is requesting something for the pain. What is the nurse's priority intervention?

Examining the client's cervix for dilation and effacement

A nurse teaches a new mother about neonatal weight loss in the first 3 days of life. How does the nurse explain the cause of this weight loss?

Excretion of accumulated excess fluids

A nurse is observing the electronic fetal monitor as a client in labor enters the second stage. The nurse identifies early decelerations of the fetal heart rate with a return to the baseline at the end of each contraction. What does this fetal heart rate pattern usually indicate?

Fetal head compression

The nurse is caring for a client in active labor at a birthing center. She is 100% effaced, dilated 3 cm, and at +1 station. In which stage of labor is this client?

First

The nurse is preparing to bathe a neonate born at 30 weeks of gestation. Which practices by the nurse ensure the infant's safety? Select all that apply.

Immerses the neonate fully except the head in the tub Measures the body temperature within 2 to 4 hours before giving the bath Uses cleansing agents with neutral pH and minimal dyes while giving the bath

The nurse is caring for a client during active labor. The recording on the electronic fetal monitor indicates fetal tachycardia. What should the nurse consider as a potential cause of this pattern?

Increased maternal metabolism

While caring for a client during labor, what does the nurse remember about the second stage of labor?

It ends at the time of birth

A nurse performs Leopold maneuvers on a newly admitted client in labor. Palpation reveals a soft, firm mass in the fundus; a firm, smooth mass on the mother's left side; several knobs and protrusions on the mother's right side; and a hard, round, movable mass in the pubic area with the brow on the right. On the basis of these findings, the nurse determines that the fetal position is what?

LOA

A client who is having her labor induced with oxytocin has internal fetal monitoring in place. Her contractions are occurring every 2 minutes, are lasting 70 seconds, and are reaching 65 mm Hg on an intrauterine pressure catheter. The baseline fetal heart rate is 130 to 140 beats/min with variability of about 15 beats/min. The nurse notices that with the last two contractions the fetal heart rate began to drop during the peak of the contraction to 110 beats/min, where it remained for about 40 seconds before returning to baseline. What type of pattern is this?

Late decelerations

A client is admitted to the birthing room in active labor. The nurse determines that the fetus is in the left occiput posterior (LOP) position. At which point can the fetal heart be heard?

Left lower quadrant

A vaginal examination reveals that a client's cervix is 90% effaced and dilated to 6 cm. The fetus's head is at station 0, and the fetus is in a right occiput anterior (ROA) position. The contractions are occurring every 3 to 4 minutes, are lasting 60 seconds, and are of moderate intensity. What should the nurse record about the client's stage of labor?

Midway through first stage of labor

When calculating the Apgar score for a newborn, what does the nurse assess in addition to the heart rate?

Muscle tone

A client in labor is having an indwelling urinary catheter inserted. What should the nurse plan to do to prevent late decelerations of the fetal heart rate during this procedure?

Place a rolled towel under the client's right hip.

A nurse is caring for a pregnant woman in active labor who is lying in bed in the high Fowler position. Epidural anesthesia and an oxytocin infusion were started 45 minutes ago. The client complains of feeling lightheaded and nauseated. What should the nurse do first after reviewing the client's admission data, vital signs, and current status? -Initially: Cervix 6cm dilated, 80% effaced. Contractions 4min apart, 60sec duration. FHR 146bpm with episodic accelerations -Initial maternal vitals: 98.8*F, 88bpm, 20rpm, 132/86 -Current maternal vitals: 99*F, 76bpm, 18rpm, 110/68 Present: Cervix 7cm dilated 80% effaced. Contractions 3min apart, 70 seconds duration, FHR 118 with early decelerations

Place the client in a 15-degree side-lying position.

A client is admitted to the birthing unit in active labor. An amniotomy is performed by the healthcare provider. Which physiologic alteration does the nurse expect to occur after the procedure?

Progressive dilation and effacement

A nurse is teaching a prenatal class about the types of pain blocks that provide perineal anesthesia during labor. Which type of pain block should the nurse include in the discussion that will provide perineal anesthesia but allow the client to feel contractions and push during the second stage of labor?

Pudendal

A client who is 38 weeks pregnant presents to the labor unit for a nonstress test (NST). The resulting fetal monitor strip is shown. How does the nurse interpret this finding?

Reassuring; fetal heart rate accelerates with movement

While caring for a client in labor, the nurse notes that during a contraction there is a 15-beat-per-minute acceleration of the fetal heart rate above the baseline. What is the nurse's most appropriate action at his time?

Record the fetal response to contractions and continue to monitor the heart rate.

A fetal monitor is applied to a client in labor. The nurse should take immediate action in response to which fetal heart rate?

Repeatedly drops abruptly to 90bpm unrelated to contractions

Which statements are true regarding ectopic pregnancy? Select all that apply.

Smoking is one of the risk factors for ectopic pregnancy. Ectopic pregnancy occurs when the fertilized egg implants in the fallopian tubes. When a young women exhibits abdominal pain, ectopic pregnancy is suspected. If the adolescent exhibits abdominal pain and hypotension, the ectopic pregnancy may have ruptured.

A client's nipples become sore and tender as a result of her newborn's vigorous suckling. What should the nurse recommend that the mother attempt to alleviate the soreness? Select all that apply.

Take the prescribed analgesic medication. Expose the nipples to air several times a day. Apply hydrogel pads to the nipples after each feeding.

The nurse teaches a postpartum client how to care for her episiotomy in order to prevent infection. Which behavior indicates that the teaching has been effective?

The client washes her hands before and after she changes a perineal pad.

A client in active labor has requested epidural anesthesia for pain management . The anesthetist has completed an evaluation, and the nurse has initiated an intravenous fluid bolus. The client's partner asks why this is necessary. What is the best explanation?

There is a risk of hypotension, and the large amount of IV fluid reduces this risk.

A woman who abused drugs during pregnancy gave birth to a drug-dependent neonate. Which nursing interventions would be beneficial to the neonate? Select all that apply.

To administer smaller doses of the dependent drug To monitor the neonate carefully and closely To educate the mother about the risks of drug abuse

While assessing a neonate who was born at 42 weeks of gestation via vaginal delivery, the nurse finds that the neonate has a birth weight of 9 lb (4.1 kg). The nurse also assesses for Moro reflex and focal swelling or tenderness in the neonate. Why does the nurse perform these interventions?

To evaluate for clavicle fracture

When assessing a neonate and mother after a vaginal delivery, the nurse finds that the neonate's blood group is B positive and mother's is AB negative. The nurse also finds that the mother has a negative Coombs test. What is the appropriate intervention in this situation?

Administering Rho(D) immune globulin intramuscularly to the mother within 72 hours of delivery

The nurse is assessing a female preterm neonate after delivery. Which assessment findings does the nurse document in the hospital reports of the infant? Select all that apply.

The infant has a prominent clitoris. The hair of the infant is fine and feathery. The infant shows no resistance to the heel-to-ear maneuver.

A 37-year-old client with hypertension, type 1 diabetes and good glycemic control is pregnant for the third time. Her first child is 4 years old, and her second pregnancy resulted in a stillbirth. She is seen in the antepartum testing unit for a nonstress test (NST) at 33 weeks' gestation. What are the primary risk factors in the client's history that indicate the need for a nonstress test? Select all that apply.

The risk for placental insufficiency A history of stillbirth from her last pregnancy Maternal history of hypertension

At 38 weeks' gestation a client is admitted to the birthing unit in active labor, and an external fetal monitor is applied. Late fetal heart rate decelerations begin to appear when her cervix is dilated 6 cm, and her contractions are occurring every 4 minutes and lasting 45 seconds. What is the likely cause of these late decelerations?

Uteroplacental insufficiency

The nurse in the birthing unit is caring for several postpartum clients. Which factor will increase the risk for hypotonic uterine dystocia?

Twin gestation

On the third postpartum day, the nurse enters the room of a client who had an unexpected cesarean birth and finds her crying. The client says, "I know my baby is fine, but I can't help crying. I wanted natural childbirth so much. Why did this have to happen to me?" What should the nurse consider when responding?

A woman's self-concept may be negatively affected by a cesarean birth, and the client's statement may reflect this.

A nurse who is caring for a postpartum client expresses concern because the woman is at increased risk for hemorrhage. Which factor in the client's history alerted the nurse to this concern?

Multifetal pregnancy

When assessing a neonate immediately after birth, the nurse observes an inability to close the eyes completely. The nurse also observes drooping of the corner of the neonate's mouth, and the absence of wrinkling of the forehead and nasolabial fold. What does the nurse infer from these findings?

The neonate's cranial nerve VII was pressurized during labor.