OB Cumulative Review II (Quiz 8-13)
Which statement related to cephalopelvic disproportion (CPD) is the least accurate?
CPD can be accurately predicted
According to the CDC, which of the following are significant causes of maternal death in the United States? (Select all that apply).
Cardio-vascular disease Hemorrhage Non-cardiovascular conditions Hypertensive disorders
What is the first action the nurse performs when jaundice is noted in a neonate who is 12 hours old?
Check maternal Rh factor
Anna wants to know if her baby has Trisomy 18 as early in the pregnancy as possible. She is 8 weeks pregnant. Her physician will suggest which of the following diagnostic test?
Chorionic villi sampling (CVS)
Which clinical findings would alert the nurse that the neonate is expressing pain?
Cry face Eyes squeezed Increase in blood pressure
Which of the following are indications for labor induction?
Fetal death
What pattern of labor is the goal with a labor induction?
Firm contractions every 3 minutes
16 y/o Susie presents to the clinic, wanting a pregnancy test. What questions would be appropriate for the professional nurse to ask Susie prior to completing the pregnancy test?
Have you done a home pregnancy test? What is the first day of your last menstrual period? Have you been using birth control?
Primary prevention of preterm labor and birth include which of the following? (Select all that apply).
Identify risk factors of preterm birth for individual pregnant woman Manage risk factors for preterm birth in individual pregnant woman
Which information regarding to injuries to the infant's plexus during labor and birth is most accurate?
If the nerves are stretched with no avulsion, then they should completely recover in 3 to 6 months.
In gestational diabetes, which complication is commonly associated with poor glycemic control during early pregnancy?
Macrosomia
According to the CDC, which of the following are true?
Maternal mortality rate in the US has increased from 1987-2013
What form of heart disease in women of childbearing years generally has a benign effect on pregnancy?
Mitral valve prolapse
Zita is 39 y/o G21002 who is 7 weeks pregnant. For which of the following is she at increased risk?
Offspring with chromosomal defect
Common risk factors for breast cancer include: (select all that apply)
Older age Female Smoking
Which conditions are infants of diabetic mothers (IDMs) at a higher risk for developing?
Respiratory distress syndrome
What side effect might a patient experience during a hystosalphingogram?
Shoulder pain
Regina is in second stage of labor and after delivery of the fetal head, her physician states "we have shoulder dystocia." What is the nurse's first 2 actions? (Select all that apply).
Stay calm Call for help Provide suprapubic support
The most effective and least expensive treatment of puerperal infection is prevention. What is the most important strategy for the nurse to adopt
Strict aseptic technique, including hand washing, by all healthcare personnel
Sarah is 28 weeks pregnant and her 1 hr gtt is 149. Based on current standards, what is the nurse's next action?
Tell her she needs a 3 hr gtt
What is one of the initial signs and symptoms of puerperal infection in the postpartum client?
Temperature of 38° C (100.4° F) or higher on 2 successive days
One of the most important components of the physical assessment of the pregnant client is the determination of BP. Consistency in measurement techniques must be maintained to ensure that the nuances in the variations of the BP readings are not the result of provider error. Which techniques are important in obtaining accurate BP readings? (Select all that apply.)
The client should be seated The client's arm should be placed at the level of the heart The same arm should be used for every reading
A nurse working with an infertile couple has made the following nursing diagnosis: Sexual dysfunction related to decreased libido. Which of the following assessments is the likely reason for this diagnosis?
The couple has established a set schedule for their sexual encounters.
A woman at 24 weeks of gestation states that she has a glass of wine with dinner every evening. Why would the nurse counsel the client to eliminate all alcohol?
The fetus is placed at risk for altered brain growth.
A client with maternal phenylketonuria (PKU) has come to the obstetrical clinic to begin prenatal care. Why would this preexisting condition result in the need for closer monitoring during pregnancy?
The fetus may develop neurologic problems.
Which statement regarding the laboratory test for glycosylated hemoglobin Alc is correct?
This laboratory test measures the levels of hemoglobin Alc, which should remain at less than 7%
A client at 39 weeks of gestation has been admitted for an external version. Which intervention would the nurse anticipate the provider to order?
Tocolytic drug
The perinatal nurse understands that the purpose of the surgical "time-out" is to:
Verify that it is the correct patient and planned procedure
Which client is at greatest risk for early PPH?
Woman with severe preeclampsia on magnesium sulfate whose labor is being induced
What is One Key Question?
Would you like to become pregnant in the next year?
Susan 36 weeks gestation presents to L&D with complaint of 'something leaking from my vagina." Which of the following assessment tools will the nurse implement first to assess Susan?
Auscultate FHTs
A NICU nurse is caring for a full-term neonate being treated for group B streptococcus (GBS). The mother of the neonate is crying and shares that she cannot understand how her baby became infected. The best response by the nurse is:
"Approximately 15% to 40% of women have no symptoms but are carriers of group B streptococcus which is found in the vaginal and lower intestinal areas. What other questions do you have regarding your baby's health?"
After the Nurse Practitioner treats a 25 y/o's Bartholin cyst with incision and drainage procedure (I&D), the nurse is providing take-home instructions. The patient asks, "Will this happen again?" The nurse's best response is:
"Bartholin cysts can recur. There is another procedure that can be done to reduce risk for recurrence. Would you like to talk to the NP about it?"
23 y/o Amy delivered a baby 2 months ago and presents to the clinic with complaint of stool coming out of her vagina for the past week. The nurse suspects recto-vaginal fistula. What is the next most appropriate question the nurse should ask Amy?
"Did you deliver your baby vaginally?"
During a prenatal visit, the nurse is explaining dietary management to a woman with pregestational diabetes. Which statement by the client reassures the nurse that teaching has been effective?
"Diet and insulin needs change during pregnancy."
A primigravida has just delivered a healthy infant girl. The nurse is about to administer erythromycin ointment in the infant's eyes when the mother asks, "What is that medicine for?" How should the nurse respond?
"Erythromycin is prophylactically given to prevent a gonorrheal infection."
A woman with worsening preeclampsia is admitted to the hospital's labor and birth unit. The physician explains the plan of care for severe preeclampsia, including the induction of labor, to the woman and her husband. Which statement by the husband leads the nurse to believe that the couple needs further information?
"Since we will be here for a while, I will call my mother so she can bring the two boys—2 years and 4 years of age—to visit their mother."
A premature infant with respiratory distress syndrome (RDS) receives artificial surfactant. How does the nurse explain surfactant therapy to the parents?
"Surfactant improves the ability of your baby's lungs to exchange oxygen and carbon dioxide."
The client is being induced in response to worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active, despite several hours of oxytocin administration. She asks the nurse, "Why is this taking so long?" What is the nurse's most appropriate response?
"The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor."
A perinatal nurse is giving discharge instructions to a woman, status post suction, and curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. What is the best response by the nurse?
"The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, then it would make the diagnosis of this cancer more difficult."
Your pregnant patient is in her first trimester and is scheduled for an ultrasound. When explaining the rationale for early pregnancy ultrasound, the best response is:
"The test will help to determine how many weeks you are pregnant."
While taking a family history, 37 y/o Bernice tells the nurse her paternal grandmother had breast and colon cancer in her 60's, two paternal aunts had breast cancer in their 40's, one of those aunts also had ovarian cancer in her 40's, one paternal uncle had colon cancer in his 40's, her paternal cousin has breast cancer in her 40's, and her father had colon cancer in his 40's. She denies cancer on her mother's side of the family. Bernice states she has 2 younger sisters. Which of the following responses would be best for the nurse to say to Bernice about her reported family history?
"The types of cancers reported on your father's side of the family may be due to a gene mutation that can be passed onto to each generation. Have any of your relatives or you considered genetic testing?"
A newborn in the neonatal intensive care unit (NICU) is dying as a result of a massive infection. The parents speak to the neonatologist, who informs them of their son's prognosis. When the father sees his son, he says, "He looks just fine to me. I can't understand what all this is about." What is the most appropriate response or reaction by the nurse at this time?
"This must be a difficult time for you. Tell me how you're doing."
Which statement is the most appropriate for the nurse to make when caring for bereaved parents?
"What can I do for you?"
Which options for saying "good-bye" would the nurse want to discuss with a woman who is diagnosed with having a stillborn girl?
"When your baby is born, would you like to see and hold her?"
A healthy 60-year-old African-American woman regularly receives health care at her neighborhood clinic. She is due for a mammogram. At her first visit, her health care provider is concerned about the 3-week wait at the neighborhood clinic and made an appointment for her to have a mammogram at a teaching hospital across town. She did not keep her appointment and returned to the clinic today to have the nurse check her blood pressure. What is the most appropriate statement for the nurse to make to this client?
"Would you like me to make an appointment for you to have your mammogram here?"
On day 3 of life, a newborn continues to require 100% oxygen by nasal cannula. The parents ask if they may hold their infant during his next gavage feeding. Considering that this newborn is physiologically stable, what response should the nurse provide?
"You may hold your baby during the feeding."
Sally is 34 weeks pregnant and has a biophysical profile score of 8. She asks the nurse what does that mean? The nurse's best response is:
"Your baby has low risk for having a problem having enough oxygen in her body and your doctor will probably want to do the test again soon. I will call your doctor. "
Hannah is 39 weeks pregnant and presents to L&D for induction of labor due to preeclampsia. Her B/P is 148/90, +1 proteinuria, and FHTs are 145 with moderate variability. Her Bishop score is 5 (1 cm/50%/-2/soft/posterior). Hannah asks the nurse what does that mean? The nurse's best answer is:
"Your cervix is ready but labor may take several hours"
Endometritis is an infection that usually starts at the placental site.
'True'
Abruptio placenta is a risk factor for amniotic fluid embolism.
'True' Risk factors for amniotic fluid embolism include induction of labor, maternal age over 35, operative delivery, placenta previa, abruptio placenta, polyhydramnios, eclampsia, and cervical or uterine lacerations.
The nurse is working in a prenatal clinic caring for a patient at 28 weeks' gestation, G21001. Which of the following findings should the nurse highlight for the nurse midwife?
1 hr gtt of 143
The nurse is preparing to teach an antepartum client with GDM the correct method of administering an intermediate-acting insulin, such as neutral protamine Hagedorn (NPH), with a short-acting insulin (regular). In the correct order from 1 through 6, match the step number with the action needed to teach the client self-administration of this combination of insulin.
1. Wash hands 2. Check the insulin bottles for the expiration date 3. Gently rotate the insulin to mix it, and wipe the stopper 4. Inject air equal to the dose of NPH insulin into the vial, and remove the syringe 5. Inject air equal to the dose of regular insulin into the vial, and withdraw the medication 6. Without adding air, withdraw the correct dose of NPH insulin
What is the risk for all pregnancies to have a fetus with minor birth defects?
10-15%
Sandy G21001 is 41 weeks pregnant and presents to L&D for induction. The physician orders Pitocin to be infused at 2mU/min. The IV bag is LR 1000mL with 10 units of Pitocin. The infusion pump delivers ___mL/hour. How will the nurse program the infusion pump to deliver the medication as ordered?
12 mL/hour
When does the anterior and posterior fontanels close?
18 mos and 3 mos, respectively
Which woman is at the greatest risk for psychological complications after hysterectomy?
19-year-old woman who had a ruptured uterus after giving birth to her first child
A woman's obstetric history indicates that she is pregnant for the fifth time. One was born at 39 weeks of gestation and he is alive; one was born at 34 weeks of gestation and that one died shortly after birth; she "lost one" at 9 weeks; and she had twins born at 36 weeks of gestation and they are alive. What is her gravidity and parity using the GTPAL system?
5-1-2-1-3
Mary G10000 is 38 weeks pregnant and has been diagnosed with severe preeclampsia. The physician orders magnesium sulfate infusion for Mary, which includes a maintenance dose of 2 grams/hr. Her IV is a premixed magnesium sulfate solution of 40grams per 1000mL. What will the nurse program the infusion pump to deliver 2 grams/hr?
50 mL/hr
A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. The client shows the nurse her readings for the past few days. Which reading signals the nurse that the client may require an adjustment of insulin or carbohydrates?
50 mg/dl just after waking up from a nap. This is too low; maybe eat a snack before going to sleep.
Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. What are generalized signs and symptoms of this condition?
Abdominal distention Temperature instability Grossly bloody stools
Contraindications for induction of labor include:
Abnormal fetal position Placental abnormalities
A postmenopausal woman has been diagnosed with two leiomyomas (fibroids). Which clinical finding is most commonly associated with the presence of leiomyomas?
Abnormal uterine bleeding
A client is diagnosed with having a stillborn infant. At first, she appears stunned by the news, cries a little, and then asks the nurse to call her mother. What is the proper term for the phase of bereavement that this client is experiencing?
Acute distress
Postoperative nursing care and education for a woman who had an abdominal hysterectomy includes (select all that apply):
Administering hormone therapy as per provider orders Assessing vaginal bleeding Instructing the woman vaginal intercourse until she has follow-up visit with surgeon Instructing the woman to resume activities as comfort level permits
According to the CDC, which of the following has the highest maternal mortality rate in the United States?
African American Women
Indications for a primary cesarean birth are often nonrecurring. Therefore, a woman who has had a cesarean birth with a low transverse scar may be a candidate for vaginal birth after cesarean (VBAC). Which clients would be less likely to have a successful VBAC? (Select all that apply.)
African-American race Delivery at a rural hospital Maternal obesity (BMI >30)
A pregnant woman arrives at the birth unit in labor at term, having had no prenatal care. After birth, her infant is noted to be small for gestational age with small eyes and a thin upper lip. The infant also is microcephalic. Based on her infant's physical findings, this woman should be questioned about her use of which substance during pregnancy?
Alcohol
Which substance, when abused during pregnancy, is the most significant cause of cognitive impairment and dysfunction in the infant?
Alcohol
A 36 y/o pregnant woman has been diagnosed with polyhydraminos. The nurse knows this is based on which of the following?
Amniotic fluid index of 30 cm
Anna is a 16 y/o G10000 who is 7 weeks pregnant. She is at increased risk for which of the following?
Anemia
Maternal risks of c-section include which of the following? (Select all that apply).
Anesthesia complications Pulmonary embolism Injuries to the bladder and bowel Increased risk for placental accreta in future pregnancy
A couple who has been attempting to become pregnant for 5 years is seeking assistance from an infertility clinic. The nurse assesses the clients' emotional responses to their infertility. Which of the following responses would the nurse expect to find? (Select all that apply.)
Anger at others who have babies Feelings of failure because they cannot make a baby Guilt on the part of one partner because he or she is unable to give the other a baby
A woman exhibits symptoms that may lead to a possible diagnosis of polycystic ovary syndrome (PCOS). While completing the initial assessment of the client, which clinical finding would the nurse not anticipate?
Anorexia
A 3.8-kg infant was vaginally delivered at 39 weeks after a 30-minute second stage. A nuchal cord was found at delivery. After birth, the infant is noted to have petechiae over the face and upper back. Which information regarding petechiae is most accurate and should be provided to the parents?
Are benign if they disappear within 48 hours of birth
Trina who is 32 weeks pregnant is brought to the ER following an MVC with multiple injuries. What should the ER team do first?
Assess Trina's injuries
Which nursing intervention is paramount when providing care to a client with preterm labor who has received terbutaline?
Assess for dyspnea and crackles
What is the first action the nurse performs when jaundice is noted in a neonate who is 32 hours old?
Assess for hyperbilirubinemia per provider's order
Sandra is 25 weeks pregnant and tells the nurse she is smoking marijuana. What is the nurse's first action?
Assess her readiness to change her behavior
Paula lives in Preston, ID. She is 24 weeks pregnant and has Class II heart disease. She presents to the ER with tachycardia and shortness of breath. What is the nurse's first action?
Assess maternal V.S.
Robin is 27 weeks pregnant and presents to the ER with c/o abdominal pain for the past 8 hours. What is the nurse's first action?
Assess the pain further
What is the highest priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy?
Assessing FHR and maternal vital signs
The obstetric provider has informed the nurse that she will be performing an amniotomy on the client to induce labor. What is the nurse's highest priority intervention after the amniotomy is performed?
Assessing the fetal heart rate (FHR)
Which nursing intervention should be immediately performed after the forceps-assisted birth of an infant?
Assessing the infant for signs of trauma
Documentation related to vacuum delivery includes which of the following:
Assessment of fetal heart rate is part of second-stage management, timing and number of applications are part of standard of care related to safe vacuum deliveries, and position and station of fetal head are noted for safe vacuum extraction. Maternal position is not critical to the documentation related to vacuum deliveries Fetal heart rate Timing and number of applications Position and station of fetal head
It is noted that the amniotic fluid of a 42-week gestation baby, born 30 seconds ago, is thick and green and he is not crying vigorously. Which of the following actions by the nurse is critical at this time?
Assist a physician with intubation and suctioning
It is noted that the amniotic fluid of a 42-week gestation baby, born 30 seconds ago, is thick and green and he is not crying vigorously. Which of the following actions by the nurse is critical at this time?
Assist the NNP with intubation and suctioning
According to the American Cancer Society, which of the following is true about screening mammogram?
Average-risk women should begin screening mammogram at 45 y/o
Instructing a woman on how to use natural family planning or fertility awareness method for contraception, the nurse should include which of the following statements? (Select all that apply)
Avoid intercourse for at least 3 days prior to ovulation Use condoms on fertile days It is safe to have intercourse during menses
The symptoms of mild-to-moderate urinary incontinence can be successfully decreased by a number of strategies. Which of these should the nurse instruct the client to use first?
Bladder training and pelvic muscle exercises
The symptoms of mild to moderate urinary incontinence can be successfully decreased by a number of strategies. Which of these should the nurse instruct the client to use first?
Bladder training and pelvic muscle exercises or Kegels
Which of the following lab tests are routinely performed on pregnant women? (Select all that apply).
Blood type Syphilis test Rubella titer
Which of the following is true about CV changes in pregnancy?
Blood volume increase by 40-50% above prepregnancy levels
Which of the following is an indication for the administration of methylergonovine (Methergine)?
Boggy uterus that does not respond to massage and oxytocin therapy
The nurse has evaluated a client with preeclampsia by assessing DTRs. The result is a grade of 3+. Which DTR response most accurately describes this score?
Brisker than expected, slightly hyperactive
The nursery nurse notes the presence of edema on one side of a baby girl's head, that does not cross the suture line. Review of the birth record indicates that her mother experienced a prolonged labor and difficult childbirth. The nurse documents the following condition in the infant's chart.
Cephalohematoma
G10000 Ginger enters L&D at 39 weeks gestation with complaint of "bag of waters broke and something is hanging down there." What is the nurse's first action?
Check her vagina/cervix
Ella is 5 hours postpartum following the vaginal delivery of a 10lb 4oz baby boy. Estimated blood loss at delivery was 900 ml. The RN is aware that Ella experienced an early-postpartum hemorrhage. Select the appropriate nursing action(s) for the care of this patient.
Check uterus more frequently to prevent atony Insert a foley catheter to make sure bladder stays empty
Approximately 10% to 15% of all clinically recognized pregnancies end in miscarriage. What are possible causes of early miscarriage? (Select all that apply.)
Chromosomal abnormalities Endocrine imbalance Systemic disorders Varicella
Which congenital anomalies can occur as a result of the use of antiepileptic drugs (AEDs) in pregnancy? (Select all that apply.)
Cleft lip Congenital heart disease Neural tube defects
As a powerful central nervous system (CNS) stimulant, which of these substances can lead to miscarriage, preterm labor, placental separation (abruption), and stillbirth?
Cocaine
Nancy G20101 is 30 weeks pregnant. She calls L&D with complaint of mild contractions every 5-10 minutes for the past 3 hours. What is the nurse's best response?
Come to L&D
Which finding on a prenatal visit at 10 weeks of gestation might suggest a hydatidiform mole? (Select all that apply).
Complaint of severe nausea Fundal height measurement of 18 cm
Which of the following can provide contraception and protection against sexually transmitted infections? (Select all that apply).
Condoms Abstinence
Preconception counseling is critical in the safe management of diabetic pregnancies. Which complication is commonly associated with poor glycemic control before and during early pregnancy?
Congenital anomalies in the fetus
Which of the following tests should never be performed during the first trimester?
Contraction Stress test
Tachysystole, previously referred as hyperstimulation, is defined as:
Contractions lasting 2 minutes or longer Five or more contractions in 10 minutes over a 30-minute window
In appraising the growth and development potential of a preterm infant, the nurse should be cognizant of the information that is best described in which statement?
Correct for milestones, such as motor competencies and vocalizations, until the child is approximately 2 years of age.
A woman has preinvasive cancer of the cervix. Which modality would the nurse discuss as an available option for a client with this condition?
Cryosurgery
A client in late middle age who is certain she is not pregnant tells the nurse during an office visit that she has urinary problems, as well as sensations of bearing down and of something in her vagina. What condition would the nurse suspect based upon this report?
Cystocele and/or rectocele
During labor induction with oxytocin, the fetal heart rate baseline is in the 120s with minimal variability. Contraction frequency is assessed to be every 1-2 minutes with duration of 60 seconds, of moderate strength to palpation. Based on this assessment, the nurse should take which action?
Decrease oxytocin infusion rate by 2 mU/min and report to provider
A woman with severe preeclampsia is receiving magnesium sulfate. Which of the following indicate she is receiving a therapeutic dose?
Decreased respirations from 24 bpm to 16 bpm
An 18-year-old client who has reached 16 weeks of gestation was recently diagnosed with pregestational diabetes. She attends her centering appointment accompanied by one of her girlfriends. This young woman appears more concerned about how her pregnancy will affect her social life than her recent diagnosis of diabetes. A number of nursing diagnoses are applicable to assist in planning adequate care. What is the most appropriate diagnosis at this time?
Deficient knowledge, related to diabetic pregnancy management
The nurse would expect a preterm delivery at 26 weeks gestation that the neonate would be born with ____________ .
Deficient surfactant
The perinatal nurse listens as Chantal describes her labor and emergency cesarean birth. Providing an opportunity to review this experience may assist Chantal in:
Developing more positive feelings about her labor and birth
Which statement concerning the complication of maternal diabetes is the most accurate?
Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.
If nonsurgical treatment for late PPH is ineffective, which surgical procedure would be appropriate to correct a common cause of this condition?
Dilation and curettage (D&C)
If nonsurgical treatment for late PPH is ineffective, which surgical procedure would be appropriate to correct the cause of this condition?
Dilation and curettage (D&C)
A primigravida is being monitored at the prenatal clinic for preeclampsia. Which finding is of greatest concern to the nurse?
Dipstick value of 3+ for protein in her urine
In caring for an immediate postpartum client, the nurse notes petechiae and oozing from her intravenous (IV) site. The client would be closely monitored for which clotting disorder?
Disseminated Intravascular Coagulation (DIC)
Which is the most accurate description of PPD without psychotic features?
Distinguishable by irritability
Breast pain occurs in many women during their perimenopausal years. Which information is (are) a priority for the nurse to share with the client? (Select all that apply).
Distinguishing between cyclical and noncyclical pain is important Assess for prior trauma or possible infection
The nurse is teaching a client with preterm premature rupture of membranes (PPROM) regarding self-care activities. Which activities should the nurse include in her teaching?
Do not engage in sexual activity.
A newborn who is a few hours old is noted to have a rash with vesicles on the chest. What is the most appropriate action of the nurse?
Document findings
A number of metabolic changes occur throughout pregnancy. Which physiologic adaptation of pregnancy will influence the nurse's plan of care?
During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus.
When caring for a pregnant woman with cardiac problems, the nurse must be alert for the signs and symptoms of cardiac decompensation. Which critical findings would the nurse find on assessment of the client experiencing this condition?
Dyspnea, crackles, and an irregular, weak pulse
Which of the following is true regarding dizygotic twins?
Each fetus has their own placenta.
Which of the following is a risk factor for ovarian cancer?
Early menarche Infertility treatments
To manage her diabetes appropriately and to ensure a good fetal outcome, how would the pregnant woman with diabetes alter her diet?
Eat her meals and snacks on a fixed schedule.
Which of the following nursing interventions are important in the prenatal care of the woman with prenatal depression? (Select all of the following).
Educate the woman about depression and plan of care, Maintain a caring relationship
A laboring woman received her epidural 5 minutes ago. Her BP was noted to drop from 128/80 to 90/55. What is the nurse's first action?
Elevate foot of bed
A woman seeks care at an infertility clinic. Which of the following tests may this woman undergo to determine what, if any, infertility problem she may have? (Select all that apply.) Select one or more:
Endometrial biopsy Hysterosalpingogram Serum FSH analysis
A postpartum patient is bottle-feeding her baby and complains of hard, sore breasts 6 days after delivering her baby. What does the nurse suspect is occurring?
Engorgement
When assisting the mother, father, and other family members to actualize the loss of an infant, which action is most helpful?
Ensuring the baby is clothed or wrapped if the parents choose to visit with the baby
A premature infant never seems to sleep longer than an hour at a time. Each time a light is turned on, an incubator closes, or people talk near her crib, she wakes up and inconsolably cries until held. What is the correct nursing diagnosis beginning with "ineffective coping, related to"?
Environmental stress
Which neurologic condition would require preconception counseling, if at all possible?
Epilepsy
Amy is a 20 year old sexually active woman (G0000) who wants an effective birth control method. She denies any medical problems. Which of the following would the nurse not recommend to Amy?
Essure Key word is NOT recommended - essure is permanent contraception, not reversible
What information is important for the nurse to include in planning for the care of a woman who has had a vaginal hysterectomy (no oopherectomy) for fibroids?
Expect no changes in her hormone levels.
Researchers have found a number of common risk factors that increase a woman's chance of developing a breast malignancy. It is essential for the nurse who provides care to women of any age to be aware of which risk factors? (select all that apply)
Family history Age Nulliparity or first pregnancy after age 40 years
Mary has just been told that the results of her breast biopsy demonstrate that she has breast cancer. Which of the following nursing diagnosis is most appropriate for the nurse to address with Mary during this visit?
Fear and/or anxiety r/t diagnosis of breast cancer
Ultrasound can be used in antepartum care for which of the following assessments? (Select all that apply).
Fetal growth Placental position and function Adjunct use in chorionic villi sampling (CVS) Gestational age
Postoperative care of the pregnant woman who requires abdominal surgery for appendicitis includes which additional assessment?
Fetal heart rate (FHR) and uterine activity
28 y/o G22002 female presents to the clinic with c/o a soft lump in her right breast. She states it changes with her cycle and is more pronounced the week before her period. She has noticed it for 3 months. What is the nurse's first impression?
Fibrocystic changes
A macrosomic infant is born after a difficult forceps-assisted delivery. After stabilization, the infant is weighed, and the birth weight is 4550 g (9 lb, 6 oz). What is the nurse's first priority?
Frequently monitor blood glucose levels, and closely observe the infant for signs of hypoglycemia.
Which of the following antepartum tests is (are) used to evaluate a Maternal Serum Screening test that is negative for increased risk?
Further follow up test not necessary
What is the nurse's priority action when cord prolapse is noted?
Get the presenting fetal part off of the cord
A newborn was admitted to the neonatal intensive care unit (NICU) after being delivered at 29 weeks of gestation to a 28-year-old multiparous, married, Caucasian woman whose pregnancy was uncomplicated until the premature rupture of membranes and preterm birth. The newborn's parents arrive for their first visit after the birth. The parents walk toward the bedside but remain approximately 5 feet away from the bed. What is the nurse's most appropriate action?
Go to the parents, introduce him or herself, and gently encourage them to meet their infant Explain the equipment first, and then focus on the newborn
What is the most important nursing action in preventing neonatal infection?
Good handwashing or hand hygiene
A nurse caring for a family during a loss might notice that a family member is experiencing survivor guilt. Which family member is most likely to exhibit this guilt?
Grandparents
When a woman is diagnosed with postpartum depression (PPD) with psychotic features, what is the nurse's primary concern in planning the client's care?
Harming her infant
Sierra G21001 is 30 weeks pregnant. She calls L&D with complaint of mild contractions every 5-30 minutes for the past 3 hours. What is the nurse's best response?
Has your water broken?
Susan and Bill, both 39 years old, have been trying to get pregnant for 6 months with no success. Bill has fathered 2 children from another relationship and his youngest is 13 y/o. Susan has had no pregnancies but has had irregular periods for years. Which of the following will the nurse ask Susan next while taking a health history?
Have you considered infertility workup?
Susan and Bill, both 23 years old, have been trying to get pregnant for 6 months with no success. Bill has fathered 2 children from another relationship and his youngest is 3 y/o. Susan has had no pregnancies but has regular monthly periods. Which of the following will the nurse ask Susan next while taking a health history?
Have you practiced "timed-sex'?
A nurse is providing breast care education to a client after mammography. Which information regarding fibrocystic changes in the breast is important for the nurse to share?
Healthy women with fibrocystic breast disease find lumpiness with pain and tenderness in varying degrees in the breast tissue during menstrual cycles.
The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the oxytocin (Pitocin) infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a platelet count of 90,000 mm3, an elevated aspartate aminotransaminase (AST) level, and a falling hematocrit. The laboratory results are indicative of which condition?
Hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome
To explain hemolytic disorders in the newborn to new parents, the nurse who cares for the newborn population must be aware of the physiologic characteristics related to these conditions. What is the most common cause of pathologic hyperbilirubinemia?
Hemolytic disorders
16 year old Emily lives in Blackfoot, ID. She has a boyfriend but does not want to have a baby for at least 10 years. She wants an effective, easy birth control method and denies medical problems. She has periods every 4-6 weeks. The nurse would recommend which of the following methods to Emily? (Select all that apply).
Hormonal IUD The implant
When a postpartum mother c/o feelings of sadness and anxiety, crying, difficulty sleeping and loss of appetite, what question(s) should the nurse ask to help determine if this mother has postpartum depression or baby blues?
How long have you had these feelings?
A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the client and documents the following findings: temperature of 37.1° C, pulse rate of 96 beats per minute, respiratory rate of 24 breaths per minute, BP of 155/112 mm Hg, 3+ DTRs, and no ankle clonus. The nurse calls the provider with an update. The nurse should anticipate an order for which medication?
Hydralazine
An infant was born 2 hours ago at 37 weeks of gestation and weighs 4.1 kg. The infant appears chubby with a flushed complexion and is very tremulous. The tremors are most likely the result of what condition?
Hypoglycemia
A diagnostic test commonly used to assess problems of the fallopian tubes is:
Hysterosalpingogram
A 32 y/o G44004 wants an effective method of contraception that she does not have think about. She is uncertain if she wants another baby. Which of the following methods would be best for the nurse to recommend to this client? (Select all that apply)
IUD Implant
Audra is G101001 and considering getting pregnant again. Her first baby was born at 29 weeks. Which of the following statements demonstrates the most need for further education?
If I do not smoke or drink alcohol, my baby won't be born early
Mary G10000 is 12 weeks pregnant in October. She is not sure if she wants the flu shot. What is the best message the nurse should include in their education for Mary?
If pregnant women get the flu, they can get seriously ill, require hospitalization and possibly die. We recommend you get the flu shot because it is a safe protective action to avoid these bad outcomes.
A 26-year-old primigravida has come to the clinic for her regular prenatal visit at 12 weeks. She appears thin and somewhat nervous. She reports that she eats a well-balanced diet, although her weight is 5 pounds less than it was at her last visit. The results of laboratory studies confirm that she has a hyperthyroid condition. Based on the available data, the nurse formulates a plan of care. Which nursing diagnosis is most appropriate for the client at this time?
Imbalanced nutrition: less than body requirements
The nurse is evaluating a neonate who was delivered 3 hours ago by vacuum-assisted delivery. The infant has developed a cephalhematoma. Which statement is most applicable to the care of this neonate?
In many infants, signs of hemorrhage in a full-term infant are absent and diagnosed only through laboratory tests
An infant at 26 weeks of gestation arrives intubated from the delivery room. The nurse weighs the infant, places him under the radiant warmer, and attaches him to the ventilator at the prescribed settings. A pulse oximeter and cardiorespiratory monitor are placed. The pulse oximeter is recording oxygen saturations of 80%. The prescribed saturations are 92%. What are the nurse's most appropriate actions at this time? (Select all that apply)
Increase oxygen Ensure patency of the endotracheal tube Listen to breath sounds Call physician
Which infant is most likely to express Rh incompatibility?
Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor
Which of the following is true regarding infertility? (Select all that apply).
Infertility is defined as the inability to achieve pregnancy after a year of unprotected intercourse, anovulation can cause primary and/or secondary infertility
Mary's cervix has been dilated to 5 cm at -1 station for 4 hours. The fetus is vertex with molding noted. Her contractions are every 3 minutes and palpate firm. FHTs are 130's with moderate variability. After reporting to the physician, he tells the nurse to start Pitocin per protocol to augment labor. The nurses best response is?
Initiate Pitocin augmentation
Which important component of nutritional counseling should the nurse include in health teaching for a pregnant woman who is experiencing cholecystitis?
Instruct the woman to eat a low-fat diet and to avoid fried foods.
In contrast to placenta previa, what is the most prevalent clinical manifestation of Grade 3 abruptio placentae?
Intense abdominal pain
The nurse is working with a 36-year-old, married client, with 6 children who smokes. The woman states, "I don't expect to have any more kids, but I hate the thought of being sterile." Which of the following contraceptive methods would be best for the nurse to recommend to this client?
Intrauterine contraceptive device (IUD)
What is the most dangerous effect on the fetus of a mother who smokes cigarettes while pregnant?
Intrauterine growth restriction
Which neonatal complications are associated with hypertension in the mother?
Intrauterine growth restriction (IUGR) and prematurity
Which options for saying "good-bye" would the nurse want to discuss with a woman who is diagnosed with having a stillborn girl?
Is an extremely intense grief reaction that persists for a long time
Which statement most accurately describes complicated grief?
Is an extremely intense grief reaction that persists for a long time
Augmentation of labor:
Is part of the active management of labor instituted when the labor process is unsatisfactory and uterine contractions are ineffective. Labor augmentation is the stimulation of ineffective UCs after the onset of spontaneous labor to manage labor dystocia. Lower doses of oxytocin are required but all of the principles pertaining to the use of oxytocin apply to augmentation.
Which is true regarding breast cyst?
It can be tender or not
Which of the following is true regarding physiologic jaundice? (Select all that apply).
Jaundice is noted 24 hours after birth Jaundice is more common in preterm infants
Which of the following is true regarding pathologic jaundice? (Select all that apply)
Jaundice is noted within 24 hours after birth
The CHOICE Project removed 3 key barriers to contraception for many women. These included which of the following?
Knowledge deficit Cost Lack of access to preferred method
A woman seeks care at an infertility center. Which of the following procedures may she undergo to determine what, if any, infertility problem she may have? (Select all that apply)
LH level Hystosalphingogram
A neonate born at 36 weeks gestation is classified as which of the following?
Late preterm
18-year-old Ellen has a positive pregnancy test and cries when she sees the result. Per her LMP, the nurse determines she is approx 7 weeks pregnant. She asks the nurse what should she do. Which of the following is the nurse's best initial response?
Let's discuss your three options
18 year old Ellen has a positive pregnancy test and cries when she sees the result. Per her LMP, the nurse determines she is approx 7 weeks pregnant. She asks the nurse what should she do. Which of the following is the nurse's best initial response?
Let's discuss your three options.
Sandra is 36 weeks pregnant and states she felt the "baby drop" 2 days ago. What term describes this?
Lightening
25 year old Susan (G0000) is thinking about getting pregnant this next year, but wants an effective method right now. She currently uses condoms. She denies medical problems. Which of the following birth control methods are most appropriate for the nurse to discuss with Susan? (Select all that apply).
Long-acting contraception is not the best choice for a woman who desires pregnancy within one year. More appropriate methods include birth control pills and the patch, and the vaginal ring as they are not long acting and are reversible once the woman stops using them. Condoms are short acting with no hormones. Oral contraceptive pills Condoms (continue) The birth control patch
Which of the following indicates a mother is entering the reorganization phase of parental grief
Looking forward to return to work
Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the client mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. This fetus is at the greatest risk for which condition?
Macrosomia
Alena is 30 weeks pregnant and her cervix is dilated to 3/80/-2. Which of the following medications does the nurse expect the physician will order?
Magnesium sulfate
During labor induction with oxytocin, the fetal heart rate baseline is in the 140s with moderate variability. Contraction frequency is assessed to be every 2-3 minutes with duration of 60 seconds, of moderate strength to palpation. Based on this assessment, the nurse should take which action?
Maintain present oxytocin infusion rate and continue to assess.
Which of the following are management options for couples faced with infertility challenges, depending of the cause? (Select all that apply).
Medication Assisted reproductive technology procedures Adoption Remain child-free
The nurse assesses a laboring woman to have dark red vaginal blood, BP of 118/70, FHT 110's, her uterus is slightly tense in between contractions, and her cervix is 1 cm dilated, anterior and 0% effaced. What is the nurse's action?
Monitor IV sites for bleeding
What is the best action a woman with pregestational diabetes can take to improve outcomes for her baby?
Monitor her blood sugars
A laboring patient received an epidural 5 minutes ago. What is the nurse's priority action?
Monitor maternal blood pressure
A patient, G1 P0, is admitted to the labor and delivery unit for induction of labor. The following assessments were made on admission: Bishop score of 4, fetal heart rate 140s with moderate variability and no decelerations, TPR 98.6°F, 88, 20, BP 120/80, negative obstetrical history. A prostaglandin suppository was inserted at that time. Which of the following findings, 6 hours after insertion, would warrant the removal of the Cervidil (dinoprostone)?
More than 5 contractions in 10 minutes
For which of the following conditions is Daily Fetal Movement Count indicated? (Select all that apply).
Mother with diabetes during pregnancy Mother with low amniotic fluid volume or oligohydraminos
By understanding the four mechanisms of heat transfer (convection, conduction, radiation, and evaporation), the nurse can create an environment for the infant that prevents temperature instability. Which significant symptoms will the infant display when experiencing cold stress?
Mottled skin with acrocyanosis
Down Syndrome is an example of which kind of inheritance pattern?
Multifactorial
Which of the following are fetal causes of dysfunctional labor? (select all that apply).
Narrow pelvis Ineffective contractions Malpresentation Malposition
Which diagnostic test is used to confirm a suspected diagnosis of breast cancer?
Needle-localization biopsy
Providing care for the neonate born to a mother who abuses substances can present a challenge for the health care team. Nursing care for this infant requires a multisystem approach. What is the first step in the provision of care for the infant?
Neonatal abstinence syndrome (NAS) scoring
Cellulitis with or without abscess formation is a fairly common condition. The nurse is providing education for a client whose presentation to the emergency department includes an infection of the breast. Which information should the nurse share with this client? (Select all that apply.)
Nipple piercing may be the cause of a recent infection Treatment for cellulitis or breast infection will include antibiotics Obesity Smoking Diabetes
In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, which finding alerts the nurse to possible adverse effects?
No DTRs
What information regarding a fractured clavicle is most important for the nurse to take into consideration when planning the infant's care?
No special treatment is necessary.
Allison is 32 weeks pregnant presents to L&D and tells the nurse she has not felt her baby move in 48 hours. The nurse begins electronic fetal monitoring and notes the baby's heart rate is in the 130's. The nurse contacts Allison's physician to obtain an order for which of the following tests?
Non-stress Test
Which of the following cancers has no accurate screening test for secondary prevention?
Ovarian cancer
Which of these medications is commonly used to control postpartum bleeding related to uterine atony?
Oxytocin
Which medications are used to manage PPH? (Select all that apply.)
Oxytocin Methergine Hemabate
Having a genetic mutation may create an 85% chance of developing breast cancer in a woman's lifetime. Which condition does not increase a client's risk for breast cancer?
Paget disease
The nurse is completing the lab order for a pap smear performed on a 22 year old female. Which of the following options will the nurse select?
Pap smear - cytology only
Which of the following screens for cervical cancer? (Select all that apply).
Pap smear test High risk HPV test
If the umbilical cord prolapses during labor, the nurse should immediately:
Perform vaginal exam and lifting the presenting part off of the cord to relieve pressure on the cord Prolapse of the umbilical cord is when the cord lies below the presenting part of the fetus. The cord becomes trapped against the presenting part and circulation is occluded; FHR will usually show bradycardia or prolonged decel. An emergency cesarean birth is typically performed. Occlusion of the cord may be partially relieved by lifting the presenting part off the cord with a vaginal exam. The examiner's hand remains in the vagina, lifting the presenting part off the cord until delivery by cesarean. There is no attempt to push the cord above the presenting part. Type and screen of blood is generally done on admission for all laboring women; type and cross-match can readily be accomplished using the blood sample already in the lab.
What is the primary nursing responsibility when caring for a client who is experiencing an obstetric hemorrhage associated with uterine atony?
Performing fundal massage
Tanya, a 30-year-old woman, is being prepared for a planned cesarean birth. The perinatal nurse assists the anesthesiologist with the spinal block and then positions Tanya in a supine position. Tanya's blood pressure drops to 90/52, and there is a decrease in the fetal heart rate to 110 bpm. The perinatal nurse's best response is to:
Place Tanya in a left lateral tilt
Which classification of placental separation is not recognized as an abnormal adherence pattern?
Placenta abruptio
A woman at 28 weeks of gestation experiences blunt abdominal trauma as the result of a fall. The nurse must closely observe the client for what?
Placental abruption
Which adverse prenatal outcomes are associated with the HELLP syndrome? (Select all that apply.)
Placental abruption Renal failure Maternal and fetal death
Which of the following is an early sign of infection in the neonate?
Poor feeding
Which woman has the highest risk for endometrial cancer?
Postmenopausal woman with hypertension
A woman who is 12 weeks postpartum presents with the following behavior: she reports severe mood swings and hearing voices, believes her infant is going to die, she has to be reminded to shower and put on clean clothes, and she feels she is unable to care for her baby. These behaviors are associated with which of the following?
Postpartum psychosis PPP is a variant of bipolar disorder and is the most serious form of postpartum mood disorders. Onset of symptoms can be as early as the 3rd postpartum day. Assessment findings include paranoia, delusions associated with the baby, mood swings, extreme agitation, confused thinking, inability to care for self or infant, and strange beliefs.
While providing care to the maternity client, the nurse should be aware that one of these anxiety disorders is likely to be triggered by the process of labor and birth. Which disorder fits this criterion?
Posttraumatic stress disorder (PTSD)
During active labor, the nurse notes Emily's contractions have gotten closer together and she is acting more uncomfortable. For which of the following should the nurse assess Emily more closely?
Precipitous labor
Which of the following is true about twin pregnancy?
Pregnant women with twins usually require more surveillance during their pregnancy compared to women with singleton pregnancy.
According to research, which risk factor for PPD is likely to have the greatest effect on the client postpartum?
Prenatal depression
Which of the following perinatal complications have been associated with untreated asymptomatic bacteriuria? (Select all that apply).
Preterm birth Low birth weight
The nurse who elects to work in the specialty of obstetric care must have the ability to distinguish between preterm birth, preterm labor, and low birth weight. Which statement regarding this terminology is correct?
Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of gestation.
Which preexisting factor is known to increase the risk of GDM?
Previous birth of large infant
Which of the following are indications for cesarean birth? (Select all that apply.)
Previous cesarean birth Desire for elective, non-medically indicated cesarean birth Failure to progress in labor Fetal distress
Which of the following are indications for cesarean birth? (Select all that apply)
Previous cesarean birth Placental abnormalities Previous uterine surgery Failure to progress in labor
A pregnant woman who has a history of cesarean births is requesting to have a vaginal birth after cesarean (VBAC). In which of the following situations should the nurse advise the patient that her request may be declined?
Previous uterine surgery
Infants born between 34 0/7 and 36 6/7 weeks of gestation are called late-preterm infants because they have many needs similar to those of preterm infants. Because they are more stable than early-preterm infants, they may receive care that is similar to that of a full-term baby. These infants are at increased risk for which conditions? (Select all that apply.)
Problems with thermoregulation Hyperbilirubinemia Sepsis
Infants born between 34 0/7 and 36 6/7 weeks of gestation are called latepreterm infants because they have many needs similar to those of preterm infants. Because they are more stable than early-preterm infants, they may receive care that is similar to that of a full-term baby. These infants are at increased risk for which conditions?
Problems with thermoregulation Sepsis Hyperbilirubinemia
Combination oral contraceptives, the vaginal ring and the patch contain two hormones. Which of the following is the primary hormone that stops ovulation?
Progesterone
Depo provera, or The Shot, contains which of the following hormones?
Progesterone
With hormonal contraception, which of the following hormones causes cervical mucus to thicken and helps to prevent pregnancy?
Progesterone
The perinatal nurse notes a rapid decrease in the fetal heart rate that does not recover immediately following an amniotomy. The most likely cause of this obstetrical emergency is:
Prolapsed umbilical cord Amniotomy is the artificial rupture of membranes (AROM) to induce or augment labor. This is a common procedure seen in obstetrics. Risks associated with amniotomy include umbilical cord prolapse when the presenting part is not engaged. Vasa previa or rupture of fetal vessels unsupported by the placenta is a very rare situation and usually results in rapid fetal exsanguination in the presence of bloody fluid seen following AROM.
A multipara, 26 weeks' gestation and accompanied by her husband, has just delivered a fetal demise. Which of the following nursing actions is appropriate at this time
Provide opportunities for grieving parents and family members to spend time with the baby
A multipara, 26 weeks' gestation and accompanied by her husband, has just delivered a fetal demise. Which of the following nursing actions is appropriate at this time?
Provide opportunities for grieving parents and family members to spend time with the baby
Which of the following are functions of the amniotic fluid? (Select all that apply)
Provides constant thermal environment Cushions the fetus
What nursing actions are appropriate during an eclamptic seizure? Select all that apply.
Put side rails up Turn head to one side Call for assistance
Supportive care of the infant with neonatal abstinence syndrome (NAS) include both pharmacologic and nonpharmacologic therapy. Nonpharmacologic therapy would include which of the following (select all that apply):
Quiet environment with low lighting and use of soft voices Swaddling Clustering care Use of pacifiers to promote "self-soothing"
In caring for the preterm infant, what complication is thought to be a result of high arterial blood oxygen level?
ROP
A family is visiting two surviving triplets. The third triplet died 2 days ago. What action indicates that the family has begun to grieve for the dead infant?
Refers to the dead infant in the past tense
A primigravida woman at 42 weeks' gestation received Prepidil (dinoprostone) for induction 12 hours ago. The Bishop score is now 3. Which of the following actions by the nurse is appropriate?
Report the lack of progress to the obstetrician
Despite warnings, prenatal exposure to alcohol continues to far exceed exposure to illicit drugs. Which condition is rarely associated with fetal alcohol syndrome (FAS)?
Respiratory conditions
Because of the premature infant's decreased immune functioning, what nursing diagnosis should the nurse include in a plan of care for a premature infant?
Risk for infection
When caring for clients with neoplasms of the reproductive system, the nurse must begin by assessing the woman's knowledge of the disorder, its management, and prognosis. This assessment should be followed by a nursing diagnosis. Which diagnosis fails to address the psychological effect of these disorders?
Risk for injury, related to lack of skill for self-care
The induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus. The charge nurse on the labor and delivery unit is often asked to schedule clients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction. What are appropriate indications for induction? (Select all that apply)
Rupture of membranes at or near term Post term pregnancy Fetal death
What is the difference between PROM and PPROM? (select all that apply).
Rupture of membranes before 37 weeks gestation
A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours. A cesarean section is performed for failure to progress. The fetal heart rate (FHR) before birth is 180 beats per minute with limited variability. At birth the newborn has Apgar scores of 6 and 7 at 1 and 5 minutes and is noted to be pale and tachypneic. Based on the maternal history, what is the most likely cause of this newborn's distress?
Sepsis
A primigravida at 40 weeks of gestation is having uterine contractions every 1 ½ to 2 minutes and states that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What is the likely status of this woman's labor?
She is exhibiting hypertonic uterine dysfunction
Reports have linked third trimester use of selective serotonin uptake inhibitors (SSRIs) with a constellation of neonatal signs. The nurse is about to perform an assessment on the infant of a mother with a history of a mood disorder. Which signs and symptoms in the neonate may be the result of maternal SSRI use? (Select all that apply.)
Shivering, Fever, Irritability
A health care provider performs a clinical breast examination on a woman diagnosed with fibroadenoma. How would the nurse explain the defining characteristics of a fibroadenoma? (Select all that apply).
Single lump in one breast that can increase in size Does not increase risk for breast cancer
A healthcare provider performs a clinical breast examination on a women diagnosed with fibroadenoma. How would the nurse explain the defining characteristics of a fibroadenoma? (select all that apply)
Single lump in one breast that can increase in size Does not increase risk for breast cancer
Which client(s) should the nurse report to the health care provider? (Select all that apply).
Small dimple located in the upper outer quadrant of the right breast One 2-3mm sized mobile Nontender mass in lower outer quadrant of left breast
For an infant experiencing symptoms of drug withdrawal, which intervention should be included in the plan of care?
Snugly swaddling the infant and tightly holding the baby
Parents are often asked if they would like to have an autopsy performed on their infant. Nurses who are assisting parents with this decision should be aware of which information?
Some religions prohibit autopsy.
A woman who is 30 weeks of gestation arrives at the hospital with bleeding. Which differential diagnosis would not be applicable for this client?
Spontaneous abortion
A pregnant woman at term is transported to the emergency department (ED) after a severe vehicular accident. The obstetric nurse responds and rushes to the ED with a fetal monitor. Cardiopulmonary arrest occurs as the obstetric nurse arrives. What is the highest priority for the trauma team?
Starting cardiopulmonary resuscitation (CPR)
A client is to take Clomiphene Citrate for infertility. Which of the following is the expected action of this medication?
Stimulate release of FSH and LH
It is noted that the amniotic fluid of a 39-week gestation baby, born 30 seconds ago, is clear and he is not crying vigorously. Which of the following actions by the nurse is critical at this time?
Stimulate the baby to cry
The client is undergoing treatment for ovarian cancer. Which common nutritional problems are related to gynecologic cancers and the treatment thereof? (Select all that apply.)
Stomatitis Constipation Diarrhea Nausea and vomiting
During a newborn assessment, the nurse observes grunting and retractions. What is the nurse's first action?
Suction with bulb syringe
Yolanda is 6 weeks pregnant by dates and is considering abortion. What options might be appropriate for her at this point? (Select all that apply).
Surgical abortion with aspiration Medical abortion with mifepristone and misopristol
Supportive care of the infant with neonatal abstinence syndrome (NAS) include both pharmacologic and nonpharmacologic therapy. These therapies would include which of the following:
Swaddling Clustering care Use of pacifiers to promote "self-soothing" Use of tincture of morphine Quiet environment
Pre-surgical nursing care for the woman who is going to have a hysterectomy for ovarian cancer includes which of the following? (Select all that apply).
Teach post-op routine care such as need for early ambulation Administer enema if ordered Ensure lab results are available to the surgeon prior to surgery Identification band is in place
What important, immediate postoperative care practice should the nurse remember when caring for a woman who has had a mastectomy? (Select all that apply)
The affected arm should not be use for IV therapy BP should be taken in the unaffected arm
What important, immediate postoperative care practice should the nurse remember when caring for a woman who has had a mastectomy?
The blood pressure (BP) cuff should not be applied to the affected arm.
A couple is undergoing an infertility workup. The semen analysis indicates a decreased number of sperm and immature sperm. Which of the following factors can have a potential effect on sperm maturity? (Select all that apply.)
The daily riding of a bike can be the cause of prolonged heat exposure to the testicles. Prolonged heat exposure is a gonadotoxin. A number of medications, such as calcium channel blockers, can have an effect on sperm production. Coffee has not been associated with low sperm counts. Prostatitis or other infections within the last 3 months may have an effect on the sperm analysis. This man's episode of prostatitis was 12 months prior The man rides a bike to and from work each day The man takes a calcium channel blocker for the treatment of hypertension
A nurse is providing education to a support group of women newly diagnosed with breast cancer. It is important for the nurse to discuss which factor related to breast cancer with the group?
The exact cause of breast cancer remains unknown
Which information should nurses provide to expectant mothers when teaching them how to evaluate daily fetal movement counts (DFMCs)? (Select all that apply)
The fetal alarm signal should go off when fetal movements stop entirely for 12 hours A count of less than three fetal movements in 1 hour warrants future evaluation.
While performing Leopold's maneuvers on a woman in early labor, the nurse palpates a flat area on the mother's right, a soft mass at the suprapubic bone, a hard round mass on the fundus, and small parts on the mother's left side. The nurse concludes which of the following?
The fetal attitude is breech
While performing Leopold's maneuvers on a woman in early labor, the nurse palpates a soft round mass in the fundal region, a hard round mass just above the symphysis, a small parts on the right side, and a long soft area on the left side. The nurse concludes which of the following?
The fetal presentation is vertex
Another common pregnancy-specific condition is pruritic urticarial papules and plaques of pregnancy (PUPPP). A client asks the nurse why she has developed this condition and what can be done. What is the nurse's best response?
The goal of therapy is to relieve discomfort.
Which of the following is the most effective contraception?
The implant
Which statement regarding hemolytic diseases of the newborn is most accurate?
The indirect Coombs' test is performed on the mother before birth The direct Coombs' test is performed on the cord blood after birth
What is the primary purpose for the use of tocolytic therapy to suppress uterine activity?
The most important function of tocolytic therapy is to provide the opportunity to administer antenatal glucocorticoids
Which finding would indicate to the nurse that the grieving parents have progressed to the reorganization phase of grieving?
The parents are discussing sex and a future pregnancy, even if they have not yet sorted out their feelings
17 y/o Annie presents to the clinic requesting a pregnancy test. She states her LMP was 7 weeks ago and states she never misses a period. She reports she and her partner have been using condoms 'most of the time' since she ran out of the pill 2 months ago. The nurse performs a pregnancy test and it is positive. Annie asks what the result is. What is the nurse's best response?
The test is positive. What are your thoughts about the results?
A couple who has sought infertility counseling has been told that the man's sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which of the following occur?
The testes are overheated.
27 year old Amy G0 presents to the clinic for a preconceptual visit. Her BMI is 41. What would the nurse include in their education for Amy about pregnancy and a high BMI? (Select all that apply).
There is increased risk for gestational diabetes There is increased risk for blood clot in her legs and lungs There is increased risk for preterm birth
A woman arrives at the emergency department with complaints of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary care provider finds that the cervix is closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion?
Threatened
A woman who has recently given birth complains of pain and tenderness in her leg. On physical examination, the nurse notices warmth and redness over an enlarged, hardened area. Which condition should the nurse suspect, and how will it be confirmed?
Thrombophlebitis; using real-time and color Doppler ultrasound
Human immunodeficiency virus (HIV) may be transmitted perinatally or during the postpartum period. Which statement regarding the method of transmission is most accurate?
Through the ingestion of breast milk from an infected mother
Angela asks the nurse why she needs to keep her bladder empty during labor. Which of the following is the nurse's best answer?
To allow maximum room for the baby to descend
A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment, the nurse finds the following vital signs: temperature 37.3° C, pulse rate 88 beats per minute, respiratory rate 10 breaths per minute, BP 148/90 mm Hg, absent deep tendon reflexes (DTRs), and no ankle clonus. The client complains, "I'm so thirsty and warm." What is the nurse's immediate action?
To discontinue the magnesium sulfate infusion
What is the primary purpose for magnesium sulfate administration for clients with preeclampsia and eclampsia?
To prevent convulsions
Prostaglandin gel has been ordered for a pregnant woman at 43 weeks of gestation. What is the primary purpose of prostaglandin administration?
To ripen the cervix in preparation for labor induction
A woman with preeclampsia has a seizure. What is the nurse's highest priority during a seizure?
To stay with the client and call for help
A woman in preterm labor at 30 weeks of gestation receives two 12-mg intramuscular (IM) doses of betamethasone. What is the purpose of this pharmacologic intervention?
To stimulate fetal surfactant production
Which substance used during pregnancy causes vasoconstriction and decreased placental perfusion, resulting in maternal and neonatal complications?
Tobacco
Nurses need to understand the basic definitions and incidence data regarding PPH. Which statement regarding this condition is most accurate?
Traditionally, PPH has been classified as early PPH or late PPH with respect to birth.
A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnant when she experiences bright red, painless vaginal bleeding. On her arrival at the hospital, which diagnostic procedure will the client most likely have performed?
Transvaginal ultrasound for placental location The symptoms, bright red and painless vaginal bleeding, indicate placental previa An ultrasound can confirm this diagnosis
What is the most common cause of birth defects in humans?
Unknown causes
The nurse should be cognizant of which condition related to skeletal injuries sustained by a neonate during labor or childbirth?
Unless a blood vessel is involved, linear skull fractures heal without special treatment.
The nurse is preparing to administer methotrexate to the client. This drug is most often used for which obstetric complication?
Unruptured ectopic pregnancy
The nurse suspects that her postpartum client is experiencing hemorrhagic shock. Which observation indicates or would confirm this diagnosis?
Urinary output of at least 30 ml/hr
The nurse suspects that her postpartum client is experiencing hemorrhagic shock. Which observation indicates or would confirm this diagnosis
Urinary output of less than 30ml/hr
Claire calls the nurse at her physician's office and complains of dysuria and urinary frequency 3 days after her vaginal delivery. After further assessment, the nurse would follow standing orders for which condition?
Urinary tract infection
A pregnant woman at 33 weeks of gestation is brought to the birthing unit after a minor automobile accident. The client is experiencing no pain and no vaginal bleeding, her vital signs are stable, and the FHR is 132 beats per minute with variability. What is the nurse's highest priority?
Using continuous EFM for a minimum of 4 hours
Which of the following are primary risk factors for subinvolution of the uterus? (Select all that apply.)
Uterine fibroids can interfere with involution. Retained placental tissue does not allow the uterus to remain contracted. Infection in the uterus is a risk factor for subinvolution. UTI does not interfere with involution of the uterus Fibroids Retained placental tissue Metritis
For which of the following does VBAC increase risk?
Uterine rupture
For which of the following conditions is colposcopy used to further evaluate need for intervention? (Select all that apply).
Vaginal cancer Cervical cancer
The exact cause of preterm labor is unknown but believed to be multifactorial. Infection is thought to be a major factor in many preterm labors. Which type of infection has not been linked to preterm birth?
Viral
For which of the following reproductive cancers is high risk HPV infection thought to be primarily responsible? (Select all that apply).
Vulvar cancer Cervical cancer Vaginal cancer
Regina G10000 is 30 weeks pregnant with twins. Which of the following surveillance activities would be included in Regina's antepartum care?
Weekly NSTs Serial ultrasounds
When a couple is using natural family planning to get pregnant, which of the following is the best time for them to have intercourse to maximize odds for pregnancy?
When the temperature falls and before it rises
New screening mammogram recommendations by ACOG include which of the following?
Women should talk to their health care provider to decide the best age to begin screening mammograms
Which information regarding the care of antepartum women with cardiac conditions is most important for the nurse to understand?
Women with class II cardiac disease should avoid heavy exertion and any activity that causes even minor symptoms.
