OB Exam 3 practice questions

promote fetal lung maturity.

A client at 28 weeks' gestation is complaining of contractions. Following admission and hydration, the physician writes an order for the nurse to give 12 mg of betamethasone I.M. This medication is given to:

placenta previa

A client in her 34th week of pregnancy presents with sudden onset of bright red vaginal bleeding. Her uterus is soft, and she's experiencing no pain. Fetal heart rate is 120 beats/minute. Based on this history, what should the nurse suspect?

Blue

A multigravid client at 34 weeks' gestation visits the hospital because she suspects that her water has broken. After testing the leaking fluid with nitrazine paper, the nurse confirms that the client's membranes have ruptured when the paper turns which color

Provide an early opportunity for the couple to see the child if desired. Offer to stay with the grieving parents. Answer the parents' questions accurately.

A nurse is assisting a grieving client and spouse to deal with the loss of their 24-week-old infant. Which of the following actions would be most appropriate from the nurse? Select all that apply

1

A primary care provider has prescribed nalbuphine hydrochloride 10 mg intravenously for a client in active labor. The pharmacy supplies a vial labeled as 50 mg in a 5-mL vial. How many milliliters should the nurse administer? Record your answer using a whole number

"The vernix indicates a different gestational age than expected."

According to the antenatal record, a newborn is 12 days post-mature. A nurse completes the initial assessment of the newborn and notes increased amounts of vernix. The mother asks why the nurse seems concerned about the presence of the vernix. Which of the following statements by the nurse is most appropriate?

to prevent further blood clot formation

Prophylactic heparin therapy is prescribed to treat thrombophlebitis in a multiparous client who gave birth 24 hours ago. After instructing the client about the medication, the nurse determines that the client understands the instructions when she states which as the purpose of the drug?

The client states the need to maintain blood glucose levels between 70 to 110 mg/dL (3.9 to 6.2 mmol/L). The client describes her planned walking program while pregnant. The client will strive to maintain a hemoglobin A1C less than 6%. The client will continue her prenatal vitamins, iron, and folic acid

The antenatal clinic nurse is educating a client with gestational diabetes soon after diagnosis. Evaluation for this client session will include which outcome? Select all that apply.

interrupted supply of maternal glucose and continued high neonatal insulin production

The nurse is caring for a newborn of a primiparous woman with insulin-dependent diabetes. When the mother visits the neonate at 1 hour after birth, the nurse explains to the mother that the neonate is being closely monitored for symptoms of hypoglycemia because of which reason?

Hypoglycemia

The nurse should be especially alert for what problem when caring for a term neonate, who weighed 10 lb (4,500 g) at birth, 1 hour after a vaginal birth?

lochia fundus bowel sounds bladder

A nurse completes postpartum assessments on every shift. Which parameters should the nurse include in the assessment? Select all that apply

enhanced bonding improved physiologic stability decreased length of stay in the neonatal intensive care unit improved breastfeeding

The nurse is discussing skin to skin care with the parents of a premature neonate. The nurse should tell the parents that the advantages of kangaroo care include which benefits? Select all that apply.

It has been found to contain the retrovirus HIV.

When caring for a multiparous client who is human immunodeficiency virus (HIV) positive and asking to breastfeed her neonate as soon as possible, the nurse should include which instructions about breast milk in the teaching plan?

Change the breast pads frequently. Expose your nipples to air part of the day. Wash your hands before handling your breast and breast-feeding. Release the baby's grasp on the nipple before removing the baby from the breast.

While instructing the client about breast-feeding, which instructions should the nurse include to help the mother prevent mastitis? Select all that apply

Fatigue related to home maintenance and caring for twins

While making a home visit to a multigravid client 2 weeks after the birth of term twins, the nurse observes that the client looks pale, has dark circles around her eyes, and is breastfeeding one of the twins. The client's apartment is clean, and nothing appears out of place. The client tells the nurse that she completed three loads of laundry this morning. What is the priorityneed to address for this client?

irritability and poor sucking.

A client who used heroin during her pregnancy gives birth to a neonate. When assessing the neonate, the nurse expects to find

Maintain a patent airway

A client with eclampsia begins to experience a seizure. Which intervention should the nurse do immediately?

"I'll need a signed consent from your daughter to give you medical information."

A 15-year-old client who is 26 weeks pregnant has been admitted to the labor and delivery unit with reports of abdominal pain. Her parents want to speak with a nurse about her condition. How should the nurse respond?

correction of fluid-electrolyte imbalance

In caring for a pregnant client with hyperemesis gravidarum, which is the priority nursing intervention?

passage of meconium by the fetus

The membranes of a multigravid client in active labor rupture spontaneously, revealing greenish-colored amniotic fluid. How does the nurse interpret this finding?

providing for dietary needs and nursing in a dark quiet room

Which intervention listed in the care plan for a client with an ectopic pregnancy requires revision?

"The corticosteroids may help my baby's lungs mature.

Which statement by the client indicates an understanding of teaching regarding use of corticosteroids during preterm labor?

Breastfeed frequently to prevent milk stasis and engorgement

A breastfeeding client asks a nurse ways to prevent mastitis. What is the nurse's best response?

stat ultrasound

A client at 15 weeks' gestation presents at the obstetrical triage unit with dark brown vaginal bleeding and continuous nausea and vomiting. Her blood pressure is 142/98 mm Hg and fundal height is 19 cm. Which prescription is most important for the nurse to request from the primary care provider?

Sudden gush of vaginal fluid

A client at 34 weeks gestation with twins asks the nurse what a sign of preterm labor would be. What is the most appropriate response by the nurse?

Use the hospital code for HIV when documenting care. Ask all family members, except the client's significant other, to wait outside when she's educating the client.

A client who is positive for human immunodeficiency virus (HIV) tells the nurse that the client's significant other is the only family member who knows the client's health status. What should the nurse do to keep the client's health status confidential? Select all that apply.

Place the isolette in a quiet area of the nursery

A client with a history of drug abuse gives birth to a low-birth-weight neonate who is experiencing drug withdrawal. Which intervention is helpful for this neonate?

Ask the client if she has any drug allergies.

A postpartum multiparous client diagnosed with endometritis is to receive intravenous antibiotic therapy with ampicillin. Before administering this drug, the nurse must take which action?

respiratory arrest

Assessment of a term neonate at 2 hours after birth reveals a heart rate of less than 100 bpm, periods of apnea approximately 25 to 30 seconds in length, and mild cyanosis around the mouth. The nurse notifies the health care provider (HCP) based on the interpretation that these findings may lead to which condition?

lethargy

The neonate of a client with type 1 diabetes is at high risk for hypoglycemia. An initial sign the nurse should recognize as indicating hypoglycemia in a neonate is

Check for presence of a cord around the neck

The nurse hears a pregnant client yell, "Oh my! The baby is coming!" After placing the client in a supine position and trying to maintain some privacy, the nurse sees that the neonate's head is being born. What should the nurse do first?

Ask the client whether she has any thoughts of hurting herself or her baby

The nurse phones a client after 8 weeks postpartum to conduct a postpartum depression screen. The client states that she isn't enjoying the baby. She resents the baby due to the attention the infant receives from her partner. She has been unable to sleep and is overwhelmed with caring for her baby. What is the most appropriate immediate action from the nurse?

bronchopulmonary dysplasia

Which complication is common in neonates who receive prolonged mechanical ventilation at birth?

Clear the neonate's airway with suction or gravity

During the first feeding, the nurse observes that the neonate becomes cyanotic after gagging on mucus. What should the nurse do first?

Change clients position

External monitoring of contractions and fetal heart rate of a multigravida in labor reveals a variable deceleration pattern on the fetal heart rate. What should the nurse do first?

shoulder dystocia

The nurse is admitting a newborn to the nursery. Report reveals that the newborn was slow to crown and delivery of the head and chin was difficult. For which complication would the nurse need to assess?

tachycardia and hypotension

A client gave birth to a healthy full-term girl 2 hours ago by cesarean birth. When assessing this client which finding requires immediate nursing action?

Use a warm moist compress over the painful area

A client is 9 days postpartum and breast-feeding her neonate. The client experiences pain, redness, and swelling of her left breast and is diagnosed with mastitis. The nurse teaching the client how to care for her infected breast should include which information?

Assess the fundus and massage it if it's boggy.

A nurse coming onto the night shift assesses a client who gave birth vaginally that morning. The nurse finds that the client's vaginal bleeding has saturated two perineal pads within 30 minutes. What is the first action the nurse should take?

"I think the health care provider should see you today. Can you come to the clinic this morning?"

A primigravid client at 38 weeks' gestation diagnosed with mild preeclampsia calls the clinic nurse to say she has had a continuous headache for the past 2 days accompanied by nausea. The client does not want to take aspirin. What should the nurse should tell the client?

Use an in-and-out catheter to empty the bladder.

A nurse cares for a woman who gave birth to a term neonate at 0600. At 1600, the woman has a distended bladder and is reporting pain of 5 on a scale of 1 to 10. The nurse reviews the client's output record. What should the nurse do first?

surfacant

Twenty-four hours after cesarean birth, a neonate at 30 weeks' gestation is diagnosed with respiratory distress syndrome (RDS). When explaining to the parents about the cause of this syndrome, the nurse should include a discussion about an alteration in the body's secretion of which substance?

absence of any seizure activity during the first 48 hours

Which outcome would the nurse identify as the priority to achieve when developing the plan of care for a primigravid client at 38 weeks' gestation who is hospitalized with severe preeclampsia and receiving intravenous magnesium sulfate?

The neonate has difficulty coordinating sucking, swallowing, and breathing.

While caring for a mother and her 1-day-old neonate born vaginally at 30 weeks' gestation, the nurse explains about the neonate's need for gavage feeding at this time instead of the mother's plan for bottle feeding. What should the nurse include as the rationale for this feeding plan?

a darkened private room as close to the nurses' station as possible

The nurse is admitting a primigravid client at 37 weeks' gestation who has been diagnosed with preeclampsia to the labor and birth area. Which client care rooms is most appropriate for this client?

"I can understand your need to find an answer to what caused this. Tell me about how you are feeling."

A client has given birth to an unresponsive 24-week gestation fetus. Shortly after giving birth, the client turns to the nurse and says, "What do you think caused my baby to die? What did I do wrong?" Which of the following responses from the nurse would be most appropriate?

cesarean section

A client with active genital herpes is admitted to the labor and birth unit. During the first stage of labor. Which type of birth should the nurse anticipate for this client?

temperature.

A primigravid client at 30 weeks' gestation has been admitted to the hospital with premature rupture of the membranes without contractions. Her cervix is 2 cm dilated and 50% effaced. Which factor is most important for the nurse to assess next?

history of high blood pressure known drug sensitivity to methylergonovine maleate cardiac disease

The nurse is caring for a client who has had a postpartum hemorrhage. The healthcare provider has prescribed methylergonovine maleate. What would be a contraindication for a client who has been prescribed this medication? Select all that apply.

postpartum psychosis

The nurse makes a home visit to a primigravid client on the fourth postpartum day after birth of a term neonate. When the nurse enters the house, the nurse finds the client sitting in a chair, crying inconsolably, while the neonate is crying in another room. The client tells the nurse that she has not been sleeping well and has been hearing voices. The nurse determines that the client is most likely experiencing which condition

"I can understand your need to find an answer to what caused this. Let's talk about this further."

A client and her partner just experienced spontaneous bleeding at 11 weeks gestation, which resulted in the loss of the fetus. The couple wonders if the bleeding could have been caused from the client working long hours in a stressful work environment. What is the mostappropriate response from the nurse?

The neonate will be born with mature lungs. Betamethasone is a corticosteroid that induces the production of surfactant. The pulmonary maturation that results causes the fetal lungs to mature more rapidly than normal. Because the lungs are mature, the risk of respiratory distress in the neonate is lowered but not eliminated. Betamethasone also decreases the surface tension within the alveoli. Betamethasone has no influence on contractions or carrying the fetus to full term. It also does not prevent infection.

A client at 33 weeks' gestation is admitted in preterm labor. She is given betamethasone 12 mg IM q 24 hours × 2. What is the expected outcome of this drug therapy

Administer pain medication per prescription.

A client gave birth vaginally 2 hours ago and has a third-degree laceration. There is ice in place on her perineum. However, her perineum is slightly edematous, and the client is reporting pain rated 6 on a scale of 1 to 10. Which nursing intervention would be the most appropriate at this time?

Let's talk about how preterm labor occurs to help you understand what causes it.

A client hospitalized for preterm labor tells the nurse her mother-in-law blames her for "overdoing it" and causing the preterm labor. Which of the following is the most appropriate response from the nurse?

To prevent seizures

A client with gestational hypertension receives magnesium sulfate, 4 g in 50% solution I.V. over 20 minutes. What is the purpose of administering magnesium sulfate to this client

Locate an interpreter to translate before the couple signs the consent

The nurse is caring for a non-English speaking couple. The female partner is 34 weeks pregnant and is experiencing nausea and backache for the past 12 hours. The heath care professional (HCP) has ordered a biophysical profile (BPP) test. Which of the following is the best action for the nurse to obtain consent

sterile gloves sterile lubricant Intact membranes act as a barrier to prevent infections. Once a client's membranes have ruptured, it is important to take precautions to limit introducing bacteria into the genital tract. Using sterile gloves and sterile lubricant for cervical checks help reduce the risk of infection. A sterile speculum is only needed to diagnose if the membranes have ruptured. An amnio hook would only be indicated if the plan was to artificially rupture the membranes. Cervical dilators are not used for cervical checks in labor.

The nurse is preparing to assist the health care provider (HCP) with a cervical check for a client whose membranes have ruptured. What equipment should the nurse have ready for the HCP? Select all that apply

-2 station low-birth-weight infant rupture of membranes breech presentation Having the fetus at a negative station places the client at risk for cord prolapse. With a negative station, there is room between the fetal head and the maternal pelvis for the cord to slip through. A small (low birthweight) infant is more mobile within the uterus, and the cord can rest between the fetus and the inside of the uterus or below the fetal head. With a large infant, the head is usually in a vertex presentation and occludes the lower portion of the uterus, preventing the cord from slipping by. When membranes rupture, the cord can be swept through with the amniotic fluid. In a breech presentation, the fetal head is in the fundus, and smaller portions of the fetus settle into the lower portion of the uterus, allowing the cord to lie beside the fetus. Prior abortion and a low-lying placenta are not related to cord prolapse.

A client in labor is told that she must have cesarean birth as a result of a prolapsed cord. Which factors in the client's history place her at greater risk for cord prolapse? Select all that apply.

wound-edge separation fever after the first 24 hours postpartum lochia odor purulent drainage from incision

A client with gestational diabetes had a cesarean birth because the fetus was determined to be large for gestational age. The nurse should assess for which postsurgical complications? Select all that apply.

Impaired gas exchange

A neonate is admitted to the neonatal intensive care unit for observation with a diagnosis of probable meconium aspiration syndrome (MAS). The neonate weighs 10 lb, 4 oz (4,650 g) and is at 41 weeks' gestation. What would be the priority problem for this neonate?

tachypnea with excessive secretions sensitive gag reflex hyperactivity and increased muscle tone

A nurse is caring for a newborn exposed to drugs while in utero. Which behaviors will the nurse expect the newborn to exhibit? Select all that apply

Observe the neonate carefully, contact the physician, and explain her suspicions of early neonatal sepsis. Provide blow-by oxygen and monitor the neonate's respiratory status. Inform the parents that she wants to monitor the neonate closely.

A nurse is caring for a full-term neonate who is 24 hours old. Assessment findings include axillary temperature of 96.8° F (36° C), apical heart rate of 188 beats/minute, and respiratory rate of 48 breaths/minute. The mother reports that the neonate is lethargic when she tries to breast-feed and looks "like a rag doll." The mother also has a low-grade fever. Pulse oximetry reveals saturation of 89% on room air, and the neonate has dusky mucous membranes. What are the most appropriate nursing interventions? Select all that apply.

gestational hypertension.

A client, age 39, attends a regular prenatal check-up. She's 32 weeks pregnant. When assessing the client, the nurse should stay especially alert for signs and symptoms of:

renal malformations Oligohydramnios is commonly associated with renal malformations in the neonate. These malformations include renal aplasia, dysplastic kidneys, and obstructive lesions of the lower urinary tract. Hypospadias, an abnormal congenital opening of the male urethra on the underside of the penis, isn't associated with oligohydramnios. Talipes equinovarus, commonly known as clubfoot, isn't associated with oligohydramnios. Babinski's reflex, dorsiflexion of the great toe when the sole of the foot is stimulated, is a normal reflex in neonates.

A client is diagnosed with oligohydramnios during a clinic visit. Before the client gives birth, the nurse should notify the nurses working in the nursery about the diagnosis so they are aware of which complication that's commonly associated with oligohydramnios?

Assess the neonate's blood glucose level Glucose monitoring of the neonate born to a mother with diabetes is essential because the neonate is at risk for developing hypoglycemia after birth. It is not necessary to immediately assess the blood type, weight, or reflexes

A client with diabetes mellitus gives birth to a 9-lb, 10-oz (4375 g) neonate at 38 weeks. What is the nurse's priority action after the stabilization of the neonate?

enhance bonding by pointing out the neonate's features

A mother with a history of gestational hypertension gives birth to a neonate at 26 weeks' gestation. After the neonate receives surfactant through an endotracheal tube in the delivery room, a nurse takes the neonate to the neonatal intensive care unit (NICU), places the neonate on an overbed warmer, and provides mechanical ventilation. When the mother arrives in the NICU for the first time, the nurse's priority should be to

Help the client make concrete plans for the safety of herself and her children.

A multigravid client at 36 weeks' gestation who is visiting the clinic for a routine visit begins to sob and tells the nurse, "My boyfriend has been beating me up once in a while since I became pregnant, but I can't bring myself to leave him because I don't have a job and I don't know how I would take care of my other children." What is the priority action by the nurse at this time?

Assess the fetal heart rate.

A multigravid client is receiving oxytocin augmentation. When the client's cervix is dilated to 6 cm, her membranes rupture spontaneously with meconium-stained amniotic fluid. Which action should the nurse perform first

is appropriate

A neonate is experiencing respiratory distress and is using a neonatal oxygen mask. An unlicensed assistive personnel has positioned the oxygen mask as shown. The nurse is assessing the neonate and determines that the mask

fetal heart rate of 80 beats/minute A drop in fetal heart rate signals fetal distress and may indicate the need for a cesarean birth to prevent neonatal death. Maternal blood pressure, pulse rate, respiratory rate, intake and output, and description of vaginal bleeding are all important assessment factors; however, changes in these factors don't always necessitate the delivery of the neonate

A nurse is caring for a client with mild active bleeding from placenta previa. Which assessment factor indicates an emergency cesarean birth may be necessary at this time

The neonate's toes do not fan out when soles of the feet are stroked. The neonate doesn't respond when the nurse claps her hands above him. The neonate displays weak, ineffective sucking.

A nurse is performing a neurologic assessment on a 1-day-old neonate in the nursery. Which findings indicate possible asphyxia in utero? Select all that apply.

"Tell me how you are feeling about your partner's comments."

A 22-year-old primigravida approaches the nurse during the prenatal clinic and states that her partner is saying hurtful comments about her weight gain. What is the most appropriate response from the nurse?

tea and gelatin dessert.

A client with hyperemesis gravidarum is on a clear liquid diet. The nurse should serve this client:

The client feels tired but can care for herself and her new infant. The family has adequate support from one another and others. Lochia is changing from red to pink and is smaller in amount. The client has positive comments about her new infant

The nurse is providing follow-up care to a client 10 days after the birth. The nurse would anticipate what outcomes from the new mother? Select all that apply

client at 38 weeks' gestation with active herpes lesions

The nurse is working with four clients on the obstetrical unit. Which client will be the highest priority for a cesarean section?

a 19-year-old 18 weeks' intrauterine pregnancy (IUP) who is now 12 hours post motor vehicle accident with bright red vaginal bleeding

The nurse on the antenatal unit is planning care for four clients. The nurse should assess which client first:

"Your blood pressure is slightly high. I will check it again before you leave."

The nurse performs a routine prenatal assessment on a client at 35 weeks' gestation and finds vital signs: blood pressure 138/88 mm Hg, pulse 82/min, respirations 18/min, temperature 99.1° F (37.3° C). Which statement is most appropriate for the nurse to make at this time?

"If I continue to smoke during pregnancy, my baby could be born small.

The public health nurse is teaching a prenatal class about tobacco smoke during pregnancy. Which comment made by one of the class members demonstrates that the teaching was effective

Note the color, amount, and odor of the amniotic fluid.

While a 31-year-old multigravida at 39 weeks' gestation in active labor is being admitted, her amniotic membranes rupture spontaneously. The client's cervix is 5 cm dilated, the presenting part is at 0 station, and the electronic fetal heart rate pattern is reassuring. What should the nurse do first?

risk for infection

A primigravid client at 41 weeks' gestation is admitted to the hospital's labor and birth unit in active labor. After 25 hours of labor with membranes ruptured for 24 hours, the client gives birth to a healthy neonate vaginally with a midline episiotomy. Which problem should the nurse identify as the priority for the client?

Reposition the client to her left side This client is hypotensive because of decreased blood flow through the aorta. By turning the client to her left side, the nurse removes the weight of the uterus from the aorta and increases the maternal blood flow. Taking blood pressure, summoning the physician, starting oxygen, and increasing I.V. fluids aren't necessary unless repositioning doesn't relieve the symptom

A nurse needs to obtain a good monitor tracing on a client in labor The client lies in a supine position. Suddenly, she complains of feeling light-headed and becomes diaphoretic. Which action should the nurse perform first

"Phototherapy decreases the serum unconjugated bilirubin level.

A nurse places a neonate with hyperbilirubinemia under a phototherapy lamp, covering the eyes and gonads for protection. The parents asked the nurse to tell them how their baby will benefit from having phototherapy done. Which statement by the nurse is the most appropriate response about phototherapy?

blue

A nurse uses Nitrazine paper to determine whether a pregnant client's membranes have ruptured. If the membranes have ruptured, the paper will turn which color?

"I will call my physician if I notice redness, warmth, and pain in my breasts.

A postpartum client is ready for discharge. Which client statement reflects an understanding of the teaching session?

To relieve pressure on the umbilical cord

A pregnant client arrives in the emergency department and states, "My baby is coming." The nurse sees a portion of the umbilical cord protruding from the vagina. Why should the nurse apply manual pressure to the baby's head?

Refer the client to her physician.

A pregnant client calls the nurse at 22 weeks gestation to report that she is experiencing some edema of her face and hands, with puffiness in her eyelids in the morning. What is the priorityaction by the nurse?

penicillin G potassium I.V. to the client

A pregnant client is diagnosed with group B streptococcus chorioamnionitis. The nurse should expect to administer which medication to prevent fetal transmission?

insulin acts as a growth hormone on the fetus

A pregnant client with diabetes mellitus is at risk for having a large-for-gestational-age neonate because:

proteinuria

A 32-year-old multigravida returns to the clinic for a routine prenatal visit at 36 weeks' gestation. The assessments during this visit include: blood pressure 140/90 mm Hg; pulse 80 beats/min; respiratory rate 16 breaths/min. What further information should the nurse obtain to determine if this client is becoming preeclamptic?

Instruct the client to go to an emergency room for an urgent assessment

A client at 27 weeks gestation experiences uterine cramping and also secretes a small amount of bright red bleeding and mucus. The client calls her prenatal clinic nurse. Which of the following recommendations is most appropriate from the nurse?

Encourage the client to see, touch, and hold the dead neonate.

A client gives birth to a stillborn neonate at 36 weeks gestation. When caring for this client, which strategy by the nurse would be most helpful?

passage of a liquid stool with a watery ring The mother demonstrates understanding of the discharge instructions when she says that she should contact the HCP if the baby has a liquid stool with a watery ring, because this indicates diarrhea. Infants can become dehydrated very quickly, and frequent diarrhea can result in dehydration. Normally, babies fall asleep easily after a feeding because they are satisfied and content. Spitting up a tablespoon of formula is normal. However, projectile or forceful vomiting in larger amounts should be reported. Bottle-fed infants typically pass one to two light brown stools each day

After completing discharge instructions for a primiparous client who is bottle-feeding her term neonate, the nurse determines that the mother understands the instructions when the mother says that she should contact the pediatrician if the neonate exhibits which sign or symptom?

VBAC may be possible if the client has not had a classic uterine incision

Four hours after cesarean birth of a neonate weighing 8 lb, 13 oz (4,000 g), the primiparous client asks, "If I get pregnant again, will I need to have a cesarean?" When responding to the client, the nurse should base the response to the client about vaginal birth after cesarean (VBAC) on which standard of practice?

fetal heart tones

The nurse is caring for a client with unsuccessful laboring who is anticipating a caesarian section. What is the final assessment the nurse should make in the birthing room immediately before the client is transported to the operating room?