OB 1

(A) How many arteries & veins in the umbilical cord? (B) If the first cry doesn't come after the first 30 seconds of birth or post cord clamp/cut, consider what?

(A) 2 arteries, 1 vein - cord circulation is reversed - arteries: no O2 - veins: O2 (B) take respiratory measures. - if baby is blue at 1 hour of birth, think PDA malfunction

TORCH labs

- CBC - Hep B - HIV - Varicella - RH factor - RPR - rubella

1 hour post delivery, where should the uterus be?

1 below umbilicus

When do you swab for strep B?

35-37 weeks

On inspection, the nurse notes that a newborn has a normal newborn head/body proportion. This proportion for the head is: A) one-half his total length. B) one-fourth his total length. C) one-sixth his total length. D) one-eighth his total length.

B

A patient wants to calculate fertile days using the calendar method. What will the nurse instruct the patient to subtract when making this calculation? A) 14 from 28 B) 18 from the shortest period and 11 from the longest C) 18 from the longest period and 11 from the shortest D) The length of the average period from the ideal of 28

B Subtract 18 days from the shortest cycle, this predicts the first fertile day. Then subtract 11 days from the longest cycle, this represents the last fertile day.

During a home visit, a new mother tells the nurse that her nipples are sore from breast-feeding. What should the nurse instruct the mother at this time? Select all that apply. A) Insert plastic liners into the nursing bra. B) Apply lanolin to nipples after air exposure. C) Expose the nipples to air so the nipple dries. D) Position the baby differently for each feeding. E) Massage a few drops of breast milk to the areola.

B, C, D, E To help with sore nipples from breastfeeding, the nurse should instruct the mother to apply lanolin to nipples after air exposure, expose the nipples to air so the nipple dries, position the baby differently for each feeding, and massage a few drops of breast milk to the areola. The mother should be discouraged from inserting plastic liners into the nursing bra because these prevent air from circulating around the breast.

The nurse is explaining the process of breast milk production with a client pregnant with her first child. What should the nurse include when providing this teaching? Select all that apply. A) Breast milk is thin, yellow, and watery. B) For the first 3 to 4 days, the breast milk is colostrum. C) Uterine cramping is a contraindication to breastfeeding. D) True breast milk comes in by the 10th day after giving birth. E) Most mothers have breast milk by the first day after giving birth.

B, D For the first 3 to 4 days after delivery, the breast milk is colostrum. The consistency changes to true breast milk by the 10th postpartum day. Colostrum is thin, yellow, and watery. Uterine cramping occurs as a result of oxytocin released during breastfeeding and is not a contraindication to breastfeeding but an expected occurrence. Most mothers do not have breast milk by the first day after giving birth.

A nurse is working with a woman who is using the calendar method to determine her safe days. The nurse would instruct the woman to subtract: A) 14 from 28. B) 18 from her shortest period and 11 from her longest. C) The length of her average period from the ideal of 28. D) 18 from the longest period and 11 from her shortest.

B. - Keep a diary of 6 menstrual cycles - Subtract 18 from the shortest cycle, this predicts her first fertile day. - subtract 11 days from her longest cycle, this represents her last fertile day. - Avoid coitus

BUBBLE assessment

B: breasts (milk let down, engorgement?) U: Uterus (displacement? firm or boggy? Massage? If uterus is above the umbilucs it is a [+], below it is [-].) B: bladder (assess function) B: bowl/GI (have they passed gas/walked around?) L: Lochia (color, odor, amount, consistency) E: episiotomy (Did they have one, asses it!)

The nurse notices that a new mother who is beginning postpartum day 2 handles the newborn tentatively and does not kiss the child when holding him. What should the nurse suspect as the probable reason for this behavior? A) Disappointment with the child's sex B) Difficulty accepting the role changes C) Reacting normally to accepting a new child D) Cultural customs do not include kissing children

C

Which assessment on the third postpartal day would make the nurse evaluate a woman as having uterine subinvolution? A) Her uterus is 2 cm above the symphysis pubis. B) Her uterus is three finger widths under the umbilicus. C) Her uterus is at the level of the umbilicus. D) She experiences "pulling" pain while breastfeeding.

C A uterus involutes at a rate of one finger width daily. On the third postpartal day, it is normally three finger widths below the umbilicus.

When examining a newborn's eyes, the nurse would expect which assessment? A) follows your finger a full 180 degrees B) has a white rather than a red reflex C) follows a light to the midline D) produces tears when he cries

C Newborns do not usually follow past the midline until 3 months of age. They do not tear.

A postpartum patient is prescribed methylergonovine 0.2 mg for uterine subinvolution. Which action should the nurse take before administering the medication to the patient? A) Assess ambulation. B) Measure urine output. C) Measure blood pressure. D) Evaluate current hematocrit level.

C Methylergonovine can increase blood pressure and must be used with caution in patients with hypertension. The nurse should assess the blood pressure prior to administering and about 15 minutes afterward to detect this side effect. Methylergonovine does not affect ambulation, urine output, or hematocrit level.

Hematoma: Caput:

Hematoma: does not cross suture lines Caput: crosses suture lines

The estrogen content in the contraceptive pill performs which action? A) decreases the permeability of the cervical mucus. B) increases levels of LH C) interferes with endometrial proliferation D) Suppresses FSH

Suppresses FSH Estrogen has a direct effect on the pituitary gland suppressing FSH. Progesterone increases permeability of cervical musuc and endometrial proliferation.

Quickening

The feeling of a baby move inside the body. Most women change their perceptions of pregnancy based on this experience. Typically turning into a joyful one.

Can give Pitocin post partum, why?

To help decreased the risk of post partum hemorrhage.

Which of the following correctly identifies the daily caloric requirement per pound for a newborn? A) 50 to 55 B) 100 to 120 C) 150 to 170 D) 200 to 225

A

The nurse is concerned that a postpartum patient with a cervical laceration is developing hypovolemic shock. What did the nurse assess in this patient? A) Weak and rapid pulse B) Warm and flushed skin C) Elevated blood pressure D) Decreased respiratory rate

A If the loss of blood is extremely copious, a woman will quickly begin to exhibit symptoms of hypovolemic shock such as a weak and rapid pulse. The skin will be pale and clammy, and the blood pressure will fall. Respiratory rate will be increased and shallow.

A pregnant patient who has frequent allergic responses to drugs is concerned about an allergic reaction to the fetus. What information will the nurse use when responding to this patient's concern? A) Immunologic activity is decreased during pregnancy. B) The level of aldosterone during pregnancy reduces production of IgG antibodies. C) The kidneys release a hormone during pregnancy to prevent this from happening. D) The decreased corticosteroid activity during pregnancy ensures this will not happen.

A Immunologic activity is decreased during pregnancy to prevent a woman's body from rejecting the fetus.

Which assessment would lead the nurse to believe a postpartal woman is developing a urinary complication? A) At 8 hours post-delivery she has voided a total of 100 mL in four small voidings. B) She has voided a total of 1000 mL in two voidings, each spaced 1 hour apart. C) She says she is extremely thirsty. D) Her perineum is obviously edematous on inspection.

A Postpartal women who void in small amounts may be experiencing bladder overflow from retention.

The nurse is concerned that a new mother is ambivalent about the newborn and does not participate in newborn care. What action should the nurse take to help both the mother and newborn at this time? A) Contact the Social Services department. B) Schedule home care for the mother and infant. C) Assess who is going to take care of the baby at home. D) Ask the patient if it would be better that the baby is put up for adoption.

A Some patients do not openly voice a wish to give up a child, but their actions demonstrate they feel little attachment to their newborn. A woman who has doubts about wanting the baby is slow to make contact, barely touching the baby even by the time of discharge, and asking few questions about newborn care. When this happens, the hospital social service department can be of assistance in helping the patient plan the child's future. The nurse needs to do more than schedule home care for the mother and infant. The nurse should consult with Social Services that will assess who is going to care for the infant at home and find out if the patient wants to give the baby up for adoption. This is not the nurse's role.

A postpartum patient has a swollen area of purplish discoloration in the perineal area that is 5 cm in diameter. Which nursing diagnosis should the nurse use to plan care for this patient? A) Acute pain B) Risk for injury C) Risk for infection D) Ineffective peripheral tissue perfusion

A The nursing diagnosis of acute pain would be appropriate because of a collection of blood in traumatized tissue secondary to birth trauma. Risk for injury would be appropriate if the patient was demonstrating signs of postpartum depression or psychosis. Risk for infection would be appropriate if the patient had an elevated temperature. Ineffective peripheral tissue perfusion would be appropriate if the patient was demonstrating signs of thrombophlebitis.

A pregnant patient is experiencing leg cramps. What should the nurse include in the patient's teaching plan as a relief measure? (Select all that apply.) A) Avoid full leg extension. B) Elevate lower extremities. C) Elevate the legs on two pillows. D) Stand on each leg and perform a squat. E) Bend the knee and perform dorsiflexion.

A, B If a pregnant woman is experiencing frequent leg cramps, she may be advised to elevate lower extremities frequently during the day to improve circulation and avoiding full leg extension. Elevating the legs on two pillows may or may not help the patient. The patient should not be instructed to perform squats or dorsiflexion to help with the leg cramps.

A patient who is 6 months pregnant is complaining of a lumbar backache. What actions should the nurse suggest to help this patient? Select all that apply. A) Do pelvic rocking. B) Walk with head high. C) Rest and elevate the feet. D) Wear higher heeled shoes. E) Twist the spine at the hips.

A, B, C

An Rh-negative woman at 6 weeks' gestation is scheduled for a medically induced termination. Which outcomes should the nurse identify as appropriate for this patient? Select all that apply. A) Attended contraceptive counseling B) Received Rho (D) immune globulin C) Scheduled postprocedural sonogram D) Avoided strenuous activity for 3 weeks E) Experienced menstrual cycle in 2 months

A, B, C

After delivery, a patient is diagnosed with postpartal gestational hypertension. What care will the nurse provide to this patient? Select all that apply. A) Maintain on bed rest. B) Monitor urine output. C) Instruct on the purpose of a fluid restriction D) Administer magnesium sulfate as prescribed. E) Administer antihypertensive medication as prescribed.

A, B, D, E Treatment for postpartal gestational hypertension includes bed rest, monitoring of urine output, and administration of magnesium sulfate or an antihypertensive agent. Fluid restriction is not indicated for postpartal gestational hypertension.

The nurse manager of a postpartum care area is planning educational sessions for the nursing staff to support the 2020 National Health Goals for postpartum care. Which information should be included in this staff training? Select all that apply. A) Encourage postpartum patients to participate in breast-feeding. B) Provide information on reproductive life planning if requested. C) Suggest postpartum patients remain on bed rest for at least 2 postpartum days. D) Recommend new mothers to attend prenatal classes to learn infant care after delivery. E) Explain the importance of close observation to detect postpartum maternal hemorrhage.

A, B, E Nurses can help the nation achieve the 2020 National Health Goals for postpartum care by maintaining close observation in the immediate postpartal period to detect maternal hemorrhage, encouraging and supporting women as they begin breastfeeding, and ensuring women receive reproductive life planning information if desired. Bed rest and attending prenatal classes to learn newborn care are not strategies to support the 2020 National Health Goals for postpartum care.

The nurse is planning nutritional instructions for a pregnant patient who is a Mexican immigrant. On which areas should the nurse focus when preparing teaching for this patient? (Select all that apply.) A) Add fruits rich in vitamin C. B) Consume potatoes at every meal. C) Increase the intake of dairy products. D) Reduce the cooking time of vegetables. E) Limit the amount of added animal fat in foods.

A, C, D, E

On the third day postpartum, which temperature is internationally defined as a postpartal infection? A) 99.6° F (37.5° C) B) 100.4° F (38° C) C) 102.4° F (39.1° C) D) 104.2° F (40.1° C)

B A temperature over 100.4° F (38° C) past the first day postpartum is suggestive of infection.

A postpartum patient is diagnosed with a vaginal laceration. What intervention will the nurse provide to the patient at this time? A) Monitor vital signs every 30 minutes. B) Insert an indwelling urinary catheter. C) Provide stool softeners as prescribed. D) Weigh vaginal packing to estimate blood loss.

B An indwelling urinary catheter may be placed following a vaginal repair because the packing causes such pressure on the urethra it can interfere with voiding. Vital signs do not need to be monitored every 30 minutes. Stool softeners are not indicated for this type of laceration. The packing is not removed for 24 to 48 hours.

A postpartum client with thrombophlebitis states that her leg is very painful. Which nursing instruction is most appropriate to decrease the pain? A) Massage the calf of her leg. B) Keep covers off the leg. C) Apply ice above the knee. D) Encourage ambulation every two hours.

B Any restriction including tight fitting clothes or blankets on the leg can interfere with blood circulation. Uncovering or removing the constriction relieves the pain. Ice impairs circulation further exacerbating pain. Massaging the leg or encouraging ambulation could cause a clot to move and become a pulmonary embolus.

Why are postpartal women prone to urinary retention? A) Catheterization at the time of delivery reduces bladder tonicity. B) Decreased bladder sensation results from edema because of pressure of birth. C) Frequent partial voidings never relieve the bladder pressure. D) Mild dehydration causes a concentrated urine volume in the bladder.

B As the fetal head passes behind the bladder, bladder edema with loss of sensation can result.

The nurse administers methylergonovine 0.2 mg to a postpartal woman with uterine subinvolution. Which assessment should the nurse make prior to administering the medication? A) Her urine output is over 50 mL/h. B) Her blood pressure is below 140/90 mm Hg. C) She can walk without experiencing dizziness. D) Her hematocrit level is over 45%.

B Methylergonovine elevates blood pressure. It is important to assess that it is not already elevated before administration.

What is a positive sign of pregnancy? A) (+) test B) fetal movements felt by examiner C) Hegar's sign D) uterine contractions

B The positive signs of pregnancy are fetal image on sonogram, hearing the FHR and the examiner feeling fetal movement

When assessing a postpartum client who was diagnosed with a cervical laceration that has been repaired, what sign should the nurse report as a possible development of hypovolemic shock? A) warm and flushed skin B) weak and rapid pulse C) elevated blood pressure D) decreased respiratory rate

B The sign of weak and rapid pulse in the body is a compensatory mechanism attempting to increase the blood circulation. This finding needs to be reported to the health care provider and RN as soon as possible.

A fetus is capable of producing antibodies. The finding of IgM antibodies in an infant at birth implies that: A) antibodies were transferred to the fetus during pregnancy. B) the fetus contracted an infection during intrauterine life. C) the fetus's liver has reached developmental maturity. D) the mother contracted an infection during pregnancy.

B IgM antibodies are too large to cross the placenta.

The nurse works in a maternal and child care area that supports health promotion. Which activities will the nurse perform to support this philosophy? SATA. A) Planning care B) Patient teaching C) Family counseling D) New mother advocacy E) Identifying nursing diagnoses

B, C, D

A postpartal woman has a fourth-degree perineal laceration. Which of the following physician orders would you question? A) Urging her to drink all the milk on her tray B) Administration of acetaminophen and codeine for pain C) Administration of a sitz bath D) Administration of an enema

D A fourth-degree perineal laceration involves the anus; a hard object, such as an enema tip, could tear a suture.

A postpartal woman is developing a thrombophlebitis in her right leg. Which assessments would the nurse make to detect this? A) Bend her knee, and palpate her calf for pain. B) Ask her to raise her foot and draw a circle. C) Blanch a toe, and count the seconds it takes to color again. D) Assess for pedal edema.

D Calf swelling, erythema, warmth, tenderness, and pedal edema may be noted and are caused by an inflammatory process and obstruction of venous return.

On inspecting a newborn's abdomen, which finding would you note as abnormal? A) Abdomen slightly protuberant (rounded) B) Liver palpable 2 cm under the right costal margin C) Bowel sounds present at two to three per minute D) Clear drainage at the base of the umbilical cord

D Clear drainage at the base of the umbilical cord suggests the child may have a patent urachus or a fistula to the bladder.

A pregnant woman experiences frequent leg cramps. Which measure would the nurse include in her teaching plan to provide her with relief? A) elevating her leg on two pillows B) bending her knee and dorsiflexing her foot C) plantar flexing her foot and wiggling her toes D) extending her knee and dorsiflexing her foot

D Dorsiflexing the foot with the knee extended is an effective method for relieving cramps in the calf muscle.

A nurse is assessing a postpartal woman. Which behavior would the nurse interpret as an indication that the woman is entering the taking-hold phase of the postpartal period? A) She sits and rocks her infant for long intervals. B) She is eager to talk about her birth experience. C) She has not asked for anything for pain all day. D) She did her perineal care independently.

D During the taking-in phase, women tend to be dependent; during the taking-hold phase, they begin independent actions.

The nurse is inspecting a male newborn's genitalia. Which action should the nurse avoid when conducting this assessment? A) Inspecting the genital area for irritated skin B) Inspecting if the urethral opening appears circular C) Palpating if testes are descended into the scrotal sac D) Retracting the foreskin over the glans to assess for secretions

D In most male newborns, the foreskin slides back poorly from the meatal opening, so the nurse should not try to retract it. The nurse should inspect the area for irritated skin, inspect the urethral opening, and palpate the testes in the scrotal sac.

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. Which action by the nurse should be implemented first? A) Begin an IV infusion of Ringer's lactate solution. B) Assess the woman's vital signs. C) Call the woman's health care provider. D) Assess the woman's fundus.

D To have a suggested idea of the location of the bleeding, the nurse would need to assess the fundus of the client first.

The nurse is assisting a new mother begin breastfeeding. Which action is the most appropriate for the nurse to take at this time? A) Positioning the infant near her breast and stroking his cheek to encourage him to suck B) Stressing that breastfeeding is a normal process and will need minimal help learning it C) Cautioning her not to allow the infant to grasp the areola of her breast to prevent soreness D) Encouraging her to lie on her side and help the baby become wide awake by talking to him

D When a mother is first attempting to breastfeed, lying on the side with a pillow under the head is a good position to use because it relieves fatigue and allows the infant to rest on the bed and not on the mother. Stroking the cheek will cause the infant to turn away from the breast. Infants should grasp the nipple areola with the mouth. Most new mothers need some instruction and help.

Signs of pregnancy: Positive Probable Presumptive

Positive: FHR, sonogram and movements feltby examiner. Probable: Serum blood test, Chadwicks sign, Goodells sign, Hegars sign, Sonogram of gestational sac, Ballottement, Braxton hicks contractions, Fetal outline as seen by examiner. Presumptive: Breast changes, amenorrhea, N/V, fatigue, uterine enlargement, quickening, Linea nigra, melasma, striae gravidarum