OB course point practice questions for Exam 1

A nurse caring for a pregnant client in labor observes that the fetal heart rate (FHR) is below 110 beats per minute. Which interventions should the nurse perform? Select all that apply

Turn the client on her left side Administer oxygen by mask Assess client for underlying causes

A client in active labor is given spinal anesthesia. Which information would the nurse include when discussing with the client and family about the disadvantages of spinal anesthesia?

headache following anesthesia

During the assessment of a woman in labor, the nurse explains that certain landmarks are used to determine the progress of the birth. The nurse identifies which area as one of these landmarks?

ischial spine

A nurse finds the uterus of a postpartum woman to be boggy and somewhat relaxed. This a sign of which condition?

atony

A client who gave birth vaginally 16 hours ago states she does not need to void at this time. The nurse reviews the documentation and finds that the client has not voided for 7 hours. Which response by the nurse is indicated?

"It's not uncommon after birth for you to have a full bladder even though you can't sense the fullness."

The nurse is teaching the pregnant woman about nutrition for herself and her baby. Which statement by the woman indicates that the teaching was effective?

"I will need to take iron supplementation throughout my pregnancy even if I am not anemic."

A pregnant client is scheduled to undergo chorionic villus sampling (CVS) to rule out any birth defects. Ideally, when should this testing be completed?

10-12 weeks gestation

The nurse's note (above) was documented by the client's labor nurse minutes after epidural initiation. What action should the nurse take first?

Assess blood pressure

Cystic fibrosis is an example of which type of inheritance?

Autosomal recessive

Which documentation in the health record is most correct for the third stage of labor?

Begins with the time of delivery of the fetus and ends with the time of the delivery of the placenta

A pregnant client in her third trimester, lying supine on the examination table, suddenly grows very short of breath and dizzy. Concerned, she asks the nurse what is happening. Which response should the nurse prioritize?

Blood is trapped in the vena cava in a supine position

A client presents to the clinic because she thinks she may be pregnant. On examination, the nurse notes that the client's cervix and vaginal mucosa appear a bluish-purple color. The nurse interprets this finding as which sign?

Chadwick sign

At a prenatal checkup with a client 7 weeks gestation, the nurse would identify what as a normal finding?

Fetal heart sounds are heard

Fetal circulation differs from the circulatory path of the newborn infant. In utero the fetus has a hole connecting the right and left atria of the heart. This allows oxygenated blood to quickly pass to the major organs of the body. What is this hole called?

Foramen ovale

What essential organ becomes more developed during weeks 21-24 in order to prepare for delivery?

Lungs

The nurse caring for a client in preterm labor observes abnormal fetal heart rate (FHR) patterns. Which nursing intervention should the nurse perform next?

administration of oxygen by mask

A nurse is caring for a pregnant client who has been diagnosed with lordosis. The nurse offers preventive measures for which consequence of lordosis when caring for this client?

chronic backache

The nursing instructor is preparing a class presentation covering the various hormones and their functions during pregnancy. The instructor determines the class is successful when the class correctly matches which function with hCG?

continues progesterone production by corpus luteum

During a routine assessment the nurse notes the postpartum client is tachycardic. What is a possible cause of tachycardia?

delayed hemorrhage

The nurse explains Leopold maneuvers to a pregnant client. For which purposes are these maneuvers performed?

determining the presentation of the fetus determining the position of the fetus determining the lie of the fetus

Which nursing intervention is appropriate for prevention of a urinary tract infection (UTI) in the postpartum woman?

encouraging the woman to empty her bladder completely every 2 to 4 hours

A client in the first stage of labor is admitted to a health care center. The nurse caring for the client instructs her to rock on a birth ball. The nurse informs her that this causes the release of certain natural substances, which reduces the pain. To which substance is the nurse referring?

endorphins

The injection of a local anesthetic to block specific nerve pathways is referred to as:

pudendal block

The nurse is teaching a prenatal class about preparing for their expanding families. What is helpful advice from the nurse?

"The hormones of pregnancy may cause anxiety or depression postpartum."

Before becoming pregnant, a woman's heart rate averaged 72 beats per minute. The woman is now 15 weeks' pregnant. The nurse would expect this woman's heart rate to be approximately:

85 beats per minute. During pregnancy, heart rate increases by 10 to 15 beats per minute between 14 and 20 weeks of gestation, and this elevation persists to term

The fluid -filled, inner membrane sac-surrounding the fetus is which structure?

Amnion

The nurse is caring for a child with down syndrome (trisomy 21). This is an example of which type of inheritance?

Chromosome nondisjunction

A gravida 1 client is admitted in the active phase of stage 1 labor with the fetus in the LOA position. The nurse anticipates noting which finding when the membranes rupture?

Clear to straw-colored fluid

A new mother asks the postpartum nurse if her baby is getting enough nourishment from breastfeeding within the first 24 hours following birth. The nurse would provide her what information?

Colostrum, which is the first milk produced, is rich in calories and protein that nourishes the infant well.

The nurse is conducting an initial history and assessment on a client at 10 weeks gestation who is pregnant with her first child. Which question is a priority for the nurse to ask the client at this time?

Does anyone in your family or the father's family have any genetic disorders?

A client of African descent at 12 weeks gestation states concern about her fetus having a genetic disorder. Which statement by the nurse is most appropriate?

Does anyone in your or your partner's families have a genetic disorder?

A nurse is interviewing a couple who has come for a preconception visit. The couple asks the nurse about inheritance and how it occurs. When describing the concept of genes and inheritance, the nurse explains that a gene that is expressed when paired with another gene for the same trait is called:

Dominant

The nurse cares for a pregnant client at the first prenatal visit and reviews expected changes that will occur during pregnancy. Which information will the nurse include in the education?

During pregnancy blood volume can increase by at least 40%

The nurse is performing a newborn examination. What assessment finding by the nurse may identify potential chromosomal anomalies?

Ears set below the level of the eyes

A client presents to the birthing center in labor. The client's membranes have just ruptured. Which assessment is the nurse's priority?

FHR

A nurse is assessing a pregnant client. The nurse understands that hormonal changes occur during pregnancy. Which hormones would the nurse most likely identify as being inhibited during the pregnancy?

FSH and LH

What hormone change is responsible for fatigue in early pregnancy?

Progesterone

A client in her 39th week of gestation arrives at the maternity clinic stating that earlier in her pregnancy, she experienced shortness of breath. However, for the past few days, she has been able to breathe easily, but she has also begun to experience increased urinary frequency. A nurse is assigned to perform the physical examination of the client. Which observation is most likely?

Fundal height has dropped since the last recording

A multigravida client admitted in active labor has progressed well and the client and fetus have remained in good condition. Which action should the nurse prioritize if the client suddenly shouts out, "The baby is coming!"?

Inspect the perineum

General anesthesia is not used frequently in obstetrics because of the risks involved. There are physiologic changes that occur during pregnancy that make the risks of general anesthesia higher than it is in the general population. What is one of those risks?

Neonatal depression is possible

A woman is aware that she is the carrier of a sex linked recessive disease (hemophilia A); her husband is free of the disease. What frequency of this disease could she expect to see in her children?

There is a 50% chance her male children will inherit the disease

A client who has a breastfeeding newborn reports sore nipples. Which intervention can the nurse suggest to alleviate the client's condition?

Offer suggestions based on observation to correct positioning or latching

In preparing for a prenatal class to discuss the hormonal changes during pregnancy, which information would the nurse most likely include?

Over-the-counter antacids can be used to treat acid reflux with the health care provider's knowledge.

A community health nurse is visiting a 16 year old mother. The nurse explains to the client and her mother the genetic screening that is required by the state's law. The client asks why it is important to have the testing done on the infant. What is the nurse's best response?

PKU, congenital hypothyroidism, and galactosemia are conditions that could result in disability or death if untreated

The nurse is preparing an educational event for pregnant women on the topic of labor pain and birth. The nurse understands the need to include the origin of labor pain for each stage of labor. What information will the nurse present for the first stage of labor?

Pain originates from the cervix and lower uterine segment

A nursing student correctly identifies that a person outward appearance or expression of genes is referred to as the:

Phenotype

Amniotic fluid is produced throughout the pregnancy by the fetal membranes. Amniotic fluid has four major functions. What is one of these functions?

Physical protection

To help alleviate the client's fears, the nurse should mention the role of the hormone that softens the cervix and collagen in the joints, which allows dilation (dilatation) and enlargement of the birth canal. What is this hormone?

Relaxin

Which genetic condition is caused by a small gene mutation that affects protein structure, producing hemoglobin S?

Sickle cell anemia

During a routine prenatal visit, a pregnant woman reports a white, thick, vaginal discharge. She denies any itching or irritation. Which action would the nurse take next?

Tell the woman that this is entirely normal

A pregnant client at 24 weeks' gestation calls the clinic crying after a prenatal visit, where she had a pelvic exam. She states that she noticed blood on the tissue when she wiped after voiding. What initial statement by the nurse would explain this finding?

The cervix is very vascular during pregnancy, so spotting after a pelvic exam is not unusual

In developing a plan of care for a 5 year old child with down syndrome, what should be a priority for the nurse in meeting the expected growth and development outcomes for this child?

The child is enrolled in kindergarten

A multigravida client is concerned that she may deliver early. When asking the nurse what is the earliest her baby can be delivered and survive, which time frame would the nurse point out?

The end of the second trimester

The health care provider has prescribed a karyotype for a newborn. The mother questions the type of information that will be provided by the test. What information should be included in the nurse's response?

The karyotype will assess the baby's chromosomal makeup

What purpose does amniotic fluid serve in fetal development?

To allow the fetus to move about in utero Reservoir for fetal urine and respiratory tract secretions

If the monitor pattern of uteroplacental insufficiency were present, which action would the nurse do first?

Turn her or ask her to turn to her side

A nurse assesses that a 15 year old female client has not developed secondary sexual characteristics, is short in stature, and has a webbed neck. The nurse identifies this as being most likely related to which diagnosis?

Turner Syndrome

A client who requested "no drugs" in labor asks the nurse what other options are available for pain relief. The nurse reviews several options for nonpharmacologic pain relief, and the client thinks effleurage may help her manage the pain. This indicates that the nurse will:

instruct the client or her partner to perform light fingertip repetitive abdominal massage

A client appears to be resting comfortably 12 hours after giving birth to her first child. In contrast, she labored for more than 24 hours, the primary care provider had to use forceps to deliver the baby, and she had multiple vaginal examinations during labor. Based on this information what postpartum complication is the client at risk for developing?

infection

An 18-year-old pregnant woman asks the nurse why she has to have a routine alpha-fetoprotein serum level drawn. The nurse explains that this:

may reveal chromosomal abnormalities.

A nurse is explaining how hormones affect the pregnancy. Which hormone would the nurse describe as being responsible for stimulating uterine contractions during labor and birth?

oxytocin

The nurse is teaching a pregnant woman about breastfeeding. The nurse determines that the teaching was successful when the woman identifies which hormone as being released when the newborn sucks at the breast?

oxytocin

The client, who has just been walking around her room, sits down and reports leg tightness and achiness. After resting, she states she is feeling much better. The nurse recognizes that this discomfort could be due to which cause?

thromboembolic disorder of the lower extremities

A woman is 10 weeks' pregnant and tells the nurse that this pregnancy was unplanned and she has no real family support. The nurse's most therapeutic response would be to:

Encourage her to identify someone that she can talk to and share the pregnancy experience.

The partner of a pregnant client in her first trimester asks the nurse about the client's behavior recently, stating that she is very moody, seems happy one moment and is crying the next and all she wants to talk about is herself. What response would correctly address these concerns?

Pregnant women often experience mood swings and self-centeredness but this is normal.

A nurse is counseling a couple who have a 5-year-old daughter with Down syndrome. The nurse recognizes that their daughter's genome is represented by which chromosome combination?

47XX21+

The nurse is caring for a young couple who are expecting their first baby. They are experiencing the phenomenon known as couvade syndrome. What can the nurse explain to this family to help them understand this syndrome?

Couvade syndrome is when the partner begins to experience the same physical symptoms as the pregnant woman experiences

A nurse recommends to a client in labor to try concentrating intently on a photo of her family as a means of managing pain. The woman looks skeptical and asks, "How would that stop my pain?" Which explanation should the nurse give?

"It distracts your brain from the sensations of pain."

Which change related to the vital signs is expected in pregnant women?

Blood pressure decreases.

A nurse is caring for a client who has just been told that her unborn baby carries a genetic disorder associated with significant health related issues. The client asks, "Should I kill the baby?" What is the most appropriate nursing diagnosis for this client?

Decisional conflict related to continuation of pregnancy

A nurse working in the newborn nursery hears an innocent murmur on auscultation of a 24-hour old infant's chest. The nurse recognizes this as most likely the result of which condition?

Delayed fetal shunt closure

A pregnant mother may experience constipation and the increased pressure in the veins below the uterus can lead to development of what problem?

Hemorrhoids

A nurse is caring for a couple during a prenatal clinic visit. Which assessment finding would lead the nurse to suggest genetic counseling for the couple?

The mother just turned 39 years of age

A 19-year-old woman presents to the emergency department in the late stages of active labor. Assessment reveals she received no prenatal care. As part of her examination, a rapid HIV screen indicates she is HIV positive. To reduce the perinatal transmission to her infant, which intravenous medication would the nurse anticipate administering?

antiretroviral

A woman is in the fourth stage of labor. During the first hour of this stage, the nurse would assess the woman's fundus at which frequency?

every 15 minutes

At which time interval will the nurse assess the fetal heart rate of pregnant clients who are in the early active phase of labor?

every 15 to 30 minutes

A client has moved into the active phase of labor and is now at 6 cm dilated and +1 station. The nurse will monitor the contraction pattern how often?

every 30 minutes

A woman's prepregnant weight is within the normal range. During her second trimester, the nurse would determine that the woman is gaining the appropriate amount of weight when her weight increases by which amount per week?

1 lb (0.45 kg)

The nurse is preparing a client for an epidural block. Which intervention is a priority before the epidural anesthesia is started?

IV fluid bolus

A urinalysis is done on a client in her third trimester. Which result would be considered abnormal?

2+ Protein in urine

The nurse is analyzing the readout on the EFM and determines the FHR pattern is normal based on which recording?

Acceleration of at least 15 bpm for 15 seconds

Many changes occur in the body of a pregnant woman. Some of these are changes in the integumentary system. What is one change in the integumentary system called?

Melasma (chloasma)

A pregnant woman of Jewish descent comes to the clinic for counseling and tells the nurse that she is worried her baby may be born with a genetic disorder. Which disease does the nurse identify to be a risk for this client's baby based on the family's ancestry?

Tay-Sachs disease

A nurse is monitoring a female client with an epidural block. Which complication would be the most important for the nurse to monitor in the client?

respiratory depression

The nurse is reviewing the medication administration record (MAR) of a client at 39 weeks' gestation and notes that she is ordered an opioid for pain relief. Which is an assessment priority after administering?

Assess fetal HR

A nursing instructor is explaining the stages of fetal development to a group of nursing students. The instructor determines the session is successful after the students correctly choose which time period as representing the pre-embryonic stage?

From fertilization to the end of the second week after fertilization

A client at 38 weeks gestation is diagnosed with placental insufficiency. Which prescription from the health care provider will the nurse anticipate?

Prepare the client for an induction of labor

The nurse discovers that the FHM is now recording late decelerations in a client who is in labor. The nurse predicts this is most likely related to which event?

Uteroplacental insufficiency

A nurse is providing care to a postpartum woman who gave birth about 2 days ago. The client asks the nurse, "I haven't moved my bowels yet. Is this a problem?" Which response by the nurse would be most appropriate?

"It might take up to a week for your bowels to return to their normal pattern."

A mother comes in with her 17-year-old daughter to find out why she has not had a menstrual cycle for a few months. Examination confirms the daughter is pregnant with a fundal height of approximately 24 cm. The nurse interprets this finding as indicating that the daughter is approximately how many weeks pregnant?

24

A female client is a carrier of the Duchenne muscular dystrophy gene. Her male partner does not have the gene. The couple is planning to conceive and wants to understand the chances of the child acquiring the disease. What information should the nurse give to the couple?

A female child will not be affected by the condition

A group of nursing students are preparing a presentation for a health fair illustrating the structures found during a pregnancy. Which structures should the students point out form a protective barrier around the developing fetus?

Chorion and amnion

A client's older child has sickle-cell anemia, an autosomal recessive disorder. The client is now pregnant with a new partner and asks about the chances of this child having sickle-cell anemia. How does the nurse respond?

Sickle-cell anemia is a recessive gene, so the child will be affected only if your new partner also carries this gene.

The nurse is preparing to teach a community class to a group of first-time parents. Which information should the nurse include concerning what the pregnant woman's partner may experience as a normal response?

physical symptoms similar to the mother

To assess the frequency of a woman's labor contractions, the nurse would time:

the beginning of one contraction to the beginning of the next

A client is about 16 weeks' pregnant and is concerned because she feels her "abdomen" contracting. She calls the primary care provider's office and speaks to the nurse. What is the nurse's most appropriate response to this client's concern?

"What you are feeling are called Braxton Hicks contractions. They are considered practice contractions during pregnancy."

A nurse is caring for a pregnant client at 6 weeks gestation whose previous child had trisomy 13 and died shortly after birth. The family expresses concern that this child will also be affected. How should the nurse advise this family?

Discuss options for genetic screening in this pregnancy to determine if the fetus is affected

When educating parents on recessive genetic disease statistics, the nurse understands that which statement by the parents indicates an accurate understanding of genetic inheritance?

Each child will have a 25% chance of developing the disease

Some chromosomal abnormalities of number often result because of the failure of the chromosome pair to correctly separate during cell division. One type is referred to as polyploidy. The nurse recognizes that this type usually results in:

Early spontaneous abortion (miscarriage)

The nurse is teaching a class about conception. The nurse explains to the participant that which factors are necessarily for conception to occur?

Equal maturation of both sperm and ovum Ability of the sperm to reach the ovum Ability of the sperm to penetrate the ovum

The nurse is creating an educational pamphlet for pregnant mothers. Which is the best description of fetal development for the nurse to emphasize?

Gestational age, length, weight, and systems developed

The nurse is monitoring the electronic fetal heart rate monitor and notes the following: variable V-shaped decelerations in the fetal heart rate (FH)R lasting about 30 seconds, accelerations of about 5 beats/min before and after each deceleration, no overshoot, and baseline FHR within normal limits. Which response should the nurse prioritize?

Help the woman change positions: The electronic fetal heart rate monitor reading is associated with cord compression. Changing to a different position is a first intervention to determine if this will improve the oxygen to the fetus.

A woman is taking vaginal progesterone suppositories during her first trimester because her body does not produce enough naturally. She asks the nurse what the primary function of this hormone is on pregnancy. The nurse should respond

Maintains the endometrial lining of the uterus during pregnancy

A pregnant client at 38 weeks gestation receives a diagnosis of trisomy 21. The family plans to continue the pregnancy and states they want to prepare as much as possible for parenting a child with trisomy 21. What referrals should be made to support family?

Pediatric cardiology Support group for parents of children with trisomy 21 Early childhood development program

A nurse is discussing the importance of good nutrition to a young pregnant client. The nurse would point out that the growing fetus is getting nutrition from the mother via which structure?

Placenta

The nursing instructor is teaching a class on the various hormones necessary for a successful pregnancy and birthing process. The instructor determines the session is successful when the students correctly choose which hormone as being necessary after birth to ensure growth of the newborn?

Prolactin

A nurse is present when a healthcare provider tells a couple that the results of their genetic testing came back normal. Later, the nurse notes that the completed genetic report identifies the couple positive for a genetic disorder. What is the most appropriate action by the nurse?

Report it to the nursing supervisor

A pregnant client and her husband have had a session with a genetic specialist. What is the role of the nurse after the client has seen a specialist?

Review what has been discussed with the specialist

A nurse is conducting a presentation at a community health center about congenital malformations. The nurse describes that some common congenital malformations can occur and are recognized to be caused by multiple genetic and environmental factors. Which example would the nurse most likely cite?

Spina bifida

During late pregnancy, the nurse teaches a pregnant woman to lay on her left side to avoid what condition?

Supine hypotension syndrome

Which possible outcome would be a major disadvantage of any pain relief method that also affects awareness of the mother?

The mother may have difficulty working effectively with contractions

A woman with both heart disease and osteoarthritis has come to the genetics clinic for genetic screening. What would the nurse know about these two diseases?

They are multifactorial

The laboring client who is at 3 cm dilation (dilatation) and 25% effaced is asking for a narcotic for pain relief. The nurse explains this usually is not administered prior to the establishment of the active phase. What is the appropriate rationale for this practice?

This may prolong labor and increase complications

During an examination, a client at 32 weeks' gestation becomes dizzy, lightheaded, and pale while supine. What should the nurse do first?

Turn the client on her left side, which relieves pressure on the vena cava and restores venous return.

A mother has come to the clinic with her 13-year old daughter to find out why she has not started her menses. After a thorough examination and history, genetic testing is prescribed to rule out which abnormality?

Turner syndrome

A fertilized ovum is known as which structure?

Zygote

As a woman enters the second stage of labor, which would the nurse expect to assess?

feelings of being frightened by the change in contractions

In a class for expectant parents, the nurse discusses the various benefits of breastfeeding. However, the nurse also describes that there are situations involving certain women who should not breastfeed. Which examples would the nurse cite? Select all that apply

women on antithyroid medications women on antineoplastic medications women using street drugs