EVOLVE OB

A client at 36 weeks' gestation presents with severe abdominal pain, heavy vaginal bleeding, a drop in blood pressure, and in creased pulse rate. Which complication of pregnancy is suggested by these signs and symptoms? A. Hydatidiform mole B. Vena cava syndrome C. Marginal placenta previa D. Abruptio placentae

D. Abruptio placentae

Which technique would the nurse employ for an obstetrical client with a foreign body airway obstruction? A. Back blows B. Chest thrusts C. Suprapubic thrusts D. Abdominal thrusts

B. Chest thrusts

Which finding would the nurse be MOST concerned about in the client receiving a bolus of magnesium sulfate IV for the treatment of preeclampsia? A. Flushing B. Diaphoresis C. Nausea and Vomiting D. Burning at the IV side

C. Nausea and Vomiting - Nausea and Vomiting are symptoms of magnesium toxicity and can also be symptoms of worsening preeclampsia. Flushing, diaphoresis, and burning at the IV site are common side effects of the magnesium sulfate.

The nurse caring for a client receiving magnesium sulfate observes respirations of 10 breaths/minute, heart rate of 68 beats/min, and blood pressure of 88/50 mmHg. After discontinuing the magnesium sulfate, which priority action would the nurse take? A. Administer oxygen B. Inititate rescue breathing C. Initate a bolus of IV fluid D. Administer calcium gluconate

D. Administer calcium gluconate

Which finding would the nurse be MOST concerned about when reviewing the chart of a client scheduled for an amniocentesis? A. Hepatitis B B. Prior to uterine surgery C. Active genital herpes D. B-negative blood type

D. B-negative blood type - Because of the possibility of fetomaternal hemorrhage, administering Rho D immune globulin to the woman who is Rh negative is standard practice after an amniocentesis. Hepatitis B, prior uterine surgery or active genital herpes DO NOT increase the risk for maternal or neonatal complications of amniocentesis.

Which conditions INCREASE the risk for PPH? A. Twin birth B. Overdistended bladder C. Hypertonic uterine dysfunction D. Retained placental fragments E. Mild gestational hypertension

A. Twin birth B. Overdistended bladder D. Retained placental fragments -Overdistention of the uterus may lead to delayed or inadequate uterine contractions. An over distended bladder may inhibit uterine contractions. Retained placental fragments inhibit uterine contractions. Clients with ineffective uterine contractions are treated with rest and sedatives; although labor is prolonged, postpartum hemorrhage is NOT expected. Mild gestational hypertension DOES NOT interfere with uterine involution.

The nurse is admitting a client to the unit after fetal death was confirmed by ultrasound. While initiating IV therapy, the nurse notes blood continually oozing from the puncture site. Which is the nurse's next action? A. Restarting the line distal to the initial site B. Starting the prescribed infusion of oxytocin C. Informing the primary health care provider of this finding D. Placing an oxygen mask on the client and setting the flow rate at 8L/min

C. Informing the primary health care provider of this finding

Within minutes of giving birth to a healthy infant, a client displays symptoms of respiratory distress, and an amniotic fluid embolism is suspected. For which other complication would the nurse assess this client? A. Hypertension B. Uterine atony C. Thrombophlebitis D. Uncontrolled bleeding

D. Uncontrolled bleeding

The nurse is caring for a client in preterm labor who reports that she fell down the stairs and hit her chest and abdomen. Bruises are apparent on the left part of the client's lower abdomen, the back of each shoulder, and on both wrists. After obtaining vital signs, assessing the client, and interpreting the fetal monitor strip, which action would the nurse take next? A. Ambulate the client to promote circulation B. Assess for headache, epigastric pain, and blurry vision C. Ask the client if she feels safe at home. D. Determine if the client tripped over any object.

C. Ask the client if she feels safe at home.

The nurse is proving immediate postpartum care to a client. The nurse would monitor the client for which condition that is characterized by hemorrhage? A. Sheehan Syndrome B. Cushing Syndrome C. Addison Syndrome D. Schwartz-Bartter Syndrome

A. Sheehan Syndrome

A client who is in labor is admitted 30 hours after her membranes ruptured. Which condition is this client at increased risk for? A. Cord prolapse B. Placenta previa C. Chorioamnionitis D. Abruptio placentae

C. Chorioamnionitis

A multipara whose membranes have ruptured is admitted in early labor. Assessment reveals a breech presentation, cervical dilation of 3 cm, and fetal station at -2. For which complication would the nurse assess when caring for this client? A. Vaginal bleeding B. Urinary Tract Infection C. Prolapse of the umbilical cord D. Meconium in the amniotic fluid

C. Prolapse of the umbilical cord

A pregnant client is admitted with abdominal pain and heavy vaginal bleeding. Which is the immediate nursing action? A. Establish IV access B. Elevate the head of the bed C. Position the client laterally to the left D. Administer an IM analgesic

A. Establish IV access

A client who is admitted for surgery for a ruptured tubal pregnancy tells the nurse that she has shoulder pain. Which condition is the nurse concerned about based on these manifestations? A. Anxiety about the diagnosis B. Cardiac changes from hypovolemia C. Blood accumulation under the diaphragm D. Rebound tenderness from the ruptured tube

C. Blood accumulation under the diaphragm

The nurse admits a client with severe preeclampsia to the high-risk prenatal unit. Which is the next nursing intervention after the vital signs have been obtained? A. Calling the primary health care provider. B. Checking the client's reflexes C. Determining the client's blood type D. Establishing an IV line

D. Establishing an IV line

Which action would the nurse take based on receiving a laboratory report stating that a client receiving magnesium sulfate 2g/h IV for preeclampsia has a magnesium level of 6.4 mEq/L A. Stop the infusion B. Assess the client's deep tendon reflexes C. Assess the clients LOC D. Document the level on the fetal monitoring strip

D. Document the level on the fetal monitoring strip - THERAPEUTIC RANGE : 4 to 7.

Which statement by a woman with preeclampsia indicates the need for further teaching about needed dietary changes? A. "I should avoid excess salt." B. "I should drink 8 glasses of water every day." C. "I should eat whole grains and raw produce." D. "I should eat 60 to 70 grams of protein each day."

A. "I should avoid excess salt."

A client whose cervix is dilated to 8cm tells the nurse that she is very uncomfortable and wants to push. Which action would the nurse take? A. Coach her to taking panting breaths B. Prepare the birthing bed for the birth C. Assist her out of bed to the bathroom D. Administer the prescribed butorphanol

A. Coach her to taking panting breaths - This is the appropriate breathing technique for the transition phase; it prevents the client from pushing too early. The client is not fully dilated and therefore not ready to give birth. If she beings pushing before the cervix is fully dilated, cervical edema may occur. The client is in active labor; she should be offered a bedpan if she asks to go to the bathroom. Butorphanol should NOT be administered in this phase of labor because the peak of actions lasts as long as 1 hour and the duration is 1 to 3 hours, and the infant may be both with respiratory depression.

Which is the priority nursing care focus for a client at 34 weeks' gestation with contractions every 5 minutes and cervical dilation of 4cm? A. Promoting maternal/fetal well-being during labor. B. Reducing the anxiety associated with preterm labor. C. Supporting communication between the client and her partner D. Assisting the client and her partner with the breathing techniques needed as labor progresses.

A. Promoting maternal/fetal well-being during labor.

A client who had a cesarean birth is unable to void 3 hours after the removal of an indwelling catheter. How would the nurse evaluate the client for bladder distension? A. By catheterizing the client for residual urine B. By palpating the client's suprapubic area gently. C. By asking the client whether she still feels the urge to urinate. D. By determining whether the client is experiencing suprapubic pain

B. By palpating the client's suprapubic area gently.

With which problem is a low maternal serum alpha-fetoprotein associated? A. Fetal demise B. Down syndrome C. Neural tube defects D. Esophageal obstruction

B. Down syndrome

Which inference would the nurse draw when crackles are heard while auscultating the lungs of a client admitted with severe preeclampsia? A. Seizure activity is imminent. B. Pulmonary edema may have developed C. Diaphragmatic function is being impaired by the enlarged uterus. D. Bronchial constriction was precipitated by the stress of the pregnancy.

B. Pulmonary edema may have developed

Which activity would the nurse suggest for a client in labor who is having frequent painful contractions and whose cervix has been dilated 2cm for several hours without progression? A. Lying in bed on the right side. B. Therapeutic rest C. Taking a walk around the labor unit D. Using nipple stimulation to augment labor

B. Therapeutic rest

Which of thees clinical manifestations would the nurse report to the healthcare provider immediately in a client with preeclampsia? A. Audible crackles in the lower lung fields B. Weight gain of 5 pounds in 2 weeks C. Severe headache D. Generalized facial edema

C. Severe headache

Which action would the nurse take before birth when meconium staining is present? A. Monitoring the neonate's heart rate B. Assessing the neonate's respiratory effort C. Suctioning the neonate's mouth and nose D. Gathering equipment for neonatal resuscitation

D. Gathering equipment for neonatal resuscitation - If meconium staining is noted when a laboring client's water breaks, the nurse can take steps to ensure fetal safety before delivery, such as gathering equipment in anticipation of neonatal resuscitation. AFTER birth, the nurse would assess and monitor the neonate's vital signs and provide suctioning as needed.

Which nursing intervention holds the HIGHEST priority for a client with class I heart disease during the postpartum period? A. Promoting early ambulation B. Watching for signs of cardiac decompensation C. Assessing the mother's emotional reaction to the birth D. Instructing the mother about activity levels during the postpartum period

B. Watching for signs of cardiac decompensation

A primigravida at term has dark red vaginal bleeding and complains of pain continuing between contractions. The nurse palpates the abdomen, which is firm and shows no sign of relaxation. Which complication does the nurse suspect? A. Placenta previa B. Precipitous birth C. Abruptio placentae D. Breech presentation

C. Abruptio placentae

Which is the nurse's priority action when caring for an obstetrical client experiencing eclampsia? A. Turn the head to one side B. Obtain the fetal heart rate C. Administer IV analgesia D. Place an oral airway

A. Turn the head to one side - The airway should be kept patent by turning the client's head to one side or placing a pillow under the back or one shoulder if possible. Nothing should be placed in the client's mouth, including an oral airway during a seizure. Maternal safety is priority. During eclampsia administering analgesia is not a priority intervention. If possible, the fetal heart rate may be obtained after ensuring maternal safety.

The nurse applies fetal and uterine monitors to the abdomen of a client in active labor. When the client has contractions, the nurse notes a 15 beats/min deceleration of the fetal heart rate below the baseline lasting 15 seconds. Which is the next nursing action? A. Calling the primary health care provider B. Changing the maternal position C. Obtaining the maternal blood pressure D. Preparing the environment for an immediate birth

B. Changing the maternal position

Which intervention would the nurse recommend for a post-cesarean gas pain? A. Lying on the right side B. Walking around the room C. Using a straw when drinking water D. Supporting the incision when moving

B. Walking around the room

A client with hyperemesis gravidarum is receiving rehydration infusion therapy at home. Which is the priorty nursing activity for the home health nurse? A. Determine fetal well being B. Monitoring for signs of infection C. Monitoring the client for signs of electrolyte imbalance D. Teaching about changes in nutritional needs during pregnancy.

C. Monitoring the client for signs of electrolyte imbalance

Which complication would the nurse consider for a client with a fetus in a breech presentation? A. Rapid dilation of the cervix, indicating precipitate labor B. Stronger contractions, indicating progression of the labor C. Nonreassuring fetal signs, indicating prolapse of the cord D. Cessation of contractions, indicating primary uterine inertia

C. Nonreassuring fetal signs, indicating prolapse of the cord

Which statement from a pregnant client with premature rupture of membranes (PROM) demonstrates an understanding of the infection risk? Select all that apply. One, some, or all responses may be correct. A. "I will report a fever to my doctor." B. "I will wipe from front to back when using the bathroom." C. "If I have contractions, medications will be adminstered." D. "If I develop chorioamnionitis, my doctor will induce labor." E. "I will let my doctor know if I experience foul-smelling vaginal discharge"

All are correct. - The nurse would provide thorough education on signs of infection, infection prevention, and possible outcomes of infection for pregnant clients with PROM. The client would be instructed on how to keep the genital area clean and advised that nothing is to be introduced into the vagina. The client would be made aware of the importance of being vigilant for signs of infection, such as fever and foul-smelling vaginal discharge, and these signs would be reported immediately. Clients would be made aware that labor will need to be induced if chorioamnionitis develops. If preterm labor occurs, tocolytic medications can be administered to "buy time" enough for transporting the client to a hospital capable of providing preterm infant care. The additional time also allows antenatal corticosteroids or antibiotics to reach effective levels.

An amniotomy is performed in a laboring client at 42 weeks' gestation. Place the nursing care actions in their order of priority. - Checking the fetal heart rate tracings - Monitoring the client for signs of an infection - Inspecting the perineum of umbilical cord prolapse - Assessing the characteristics of the amniotic fluid

1) Check the fetal heart tracing 2) Inspect the perineum of umbilical cord prolapse. 3) Assessing the characteristics of the amniotic fluid 4) Monitoring the client for signs of an infection.

Which action would the nurse implement to enhance safety for a laboring client and fetus with a prolapsed cord? Select all that apply. One, some, or all responses may be correct. A. Increasing the client's IV fluid drip rate B. Placing the client in the extreme Trendelenburg position C. Administering oxygen to the client via a nonrebreather mask D. Immediately notifying the client's primary health care provider. E. Quickly gloving the examining hand and inserting two fingers into the vagina to the cervix.

ALL are correct.

Which risk to the fetus is associated with a maternal diagnosis of chorioamnionitis? Select all the apply. One, some, or all responses may be correct. A. Sepsis B. Bacteremia C. Pneumonia D. Cerebral Palsy E. Respiratory Distress Syndrome

ALL are correct.

Which intervention is a priority when a client's membranes spontaneously rupture at 37 weeks and there are no contractions? A. Assessing maternal temperature B. Monitoring for signs of preeclampsia C. Assessing for heavy vaginal bleeding D. Placing a fetal scalp electrode

A. Assessing maternal temperature

A client in early active labor at 40 weeks' gestation reports that her membranes ruptured 26 hours ago. Initial assessments of the fetal heart rate range between 168 and 174 beats/min. Which is the priority nursing action? A. Assessing maternal vital signs B. Planning for an emergency birth C. Administering oxygen by way of nasal cannula D. Preparing for fetal scalp blood sampling

A. Assessing maternal vital signs

Which client is most likely to require a C-Section? A. Multipara with a shoulder presentation B. Multipara with a documented station of "floating" C. Primigravida with a fetus presenting in the occiput posterior position D. Primigravida with a twin gestation with the fetuses in the vertex presentation

A. Multipara with a shoulder presentation

Which clinical condition concerns the nurse the MOST for an obstetrical client with heart disease? Select all that apply. One, some, or all responses may be correct. A. Obesity B. Anemia C. Hypertension D. Hypothyroidism E. Emotional distress

A. Obesity B. Anemia C. Hypertension E. Emotional distress - The effects of factors that increase the workload of the cardiovascular system can be reduced by appropriate treatment of coexisting conditions that increase the risk of cardiac decompensation. Conditions such as obesity, anemia, hypertension, and emotional stress should be reduced. Hypothyroidism IS NOT a condition that increases the workload of the cardiovascular system; however HYPERthyroidism does.

Which are risk factors for diabetes in pregnancy? Select all that apply. One, some, or all responses may be correct. A. Preterm birth B. Hypertension C. Cesarean birth D. Placenta previa E. Placental abruption

A. Preterm birth B. Hypertension C. Cesarean birth - Maternal complications associated with diabetes include preterm birth, hypertension, and cesarean birth. Placenta prevue and placental abruption are not directly associated with diabetes.

Which potential complication of severe preeclampsia may result from severe hypertension? A. Stroke B. Hemorrhage C. Precipitous labor D. Disseminated Intravascular Coagulation

A. Stroke

Which impending problem would the nurse suspect when caring for a client with bloody urine in the indwelling catheter collection bag, after an emergency cesarean birth? A. Surgical trauma to the bladder B. Urinary infection from the catheter C. Uterine relaxation with increased lochia D. Disseminated intravascular coagulopathy

A. Surgical trauma to the bladder

A woman who is admitted to the labor suite has herpes simplex virus 2 with active lesions in the perineal area. Which action would the nurse's plan of care include? A. Withholding oral fluid intake B. Discussing the need for formula feeding C. Obtaining a permission for a paracervical block D. Applying moist compresses to the perineal area.

A. Withholding oral fluid intake - Withholding oral intake of fluids if part of the preparation for a cesarean birth. This client has active herpes, which can be transmitted to the infant during a vaginal birth. A client with herpes may breast-feed. A paracervical block is NOT used for a planned cesarean birth. Herpes lesions should be kept as DRY AS POSSIBLE.

The nurse is assessing a client with tentative diagnosis of hydatidiform mole. Which clinical finding would the nurse anticipate? A. Hypotension B. Decreased fetal heart rate C. Unusual uterine enlargement D. Painless, heavy vaginal bleeding

B. Decreased fetal heart rate C. Unusual uterine enlargement

Which is the MOST appropriate nursing intervention for a client admitted to the high-risk prenatal unit at 35 weeks' gestation with a diagnosis of complete placenta previa? A. Applying a pad to the perineal area B. Having oxygen available at the bedside C. Allowing bathroom privileges with assistance. D. Educating the client regarding the intensive care nursery.

B. Having oxygen available at the bedside

The pregnant client asks the nurse whether changing the cat's litter box is harmful to her or the fetus. How would the nurse reply? A. "Cat litter is not harmful during pregnancy." B. "Exposure to cat litter for short periods of time is not harmful." C. "There are several factors that determine a person's response to the toxins in cat litter." D. "Fetal abnormalities are associated with exposure to cat litter, even after minimal contact."

C. "There are several factors that determine a person's response to the toxins in cat litter."

The nurse is caring for a client whose fetus is in a breech presentation. The membranes rupture and meconium appears in the vaginal introitus. Which would the nurse recognize this indicates? A. A potential for cord prolapse. B. Evidence for fetal heart abnormalities C. A common occurrence in breech presentations D. A condition requiring immediate notification of the primary health care provider.

C. A common occurrence in breech presentations - Sudden rupture of membranes followed by the appearance of meconium occurs in breech presentation when pressure on the fetal abdomen from the contractions forces meconium from the bowel. Cord prolapse is NOT an absolute; however, it may occur if the presenting part DOES NOT fill the pelvic cavity. Fetal heart abnormalities are identified by means of auscultation or continuous electronic fetal monitoring, not by the presence of meconium. Immediate notification of the primary health care provider is unnecessary.

A woman in the third trimester of pregnancy presents with vaginal bleeding and states she snorted cocaine approximately 2 hours ago. Which complication would this client profile suggest? A. Placenta previa B. Tubal pregnancy C. Abruptio placentae D. Spontaneous abortion

C. Abruptio placentae

41) The nurse is teaching a birth/prenatal class about breast-feeding. Which hormone stimulates the production of milk during lactation? A. Inhibin B. Estrogen C. Prolactin D. Progesterone

C. Prolactin