OB-Final

The nurse is providing postpartum care to a patient 24 hours after a vaginal delivery. Which action does the nurse perform prior to assessing the patient's uterus?

- Ask pt to void

The nurse is providing care for a primip (never been pregnant before this one) patient in active labor. Cervical dilation has progressed 0.5 cm in 2 hours. Intrauterine pressure catheter reading is 20 mm Hg. Which action does the nurse anticipate next?

- Augmentation of labor with oxytocin per health care provider's orders

A breastfeeding mother is planning to return to work 3 months after her baby is born. The mother is planning to use an electric breast pump and freeze some breast milk for use later. Which information does the nurse need to provide?

- Breast milk can be kept in a deep freezer for 6-12 months

The nurse is caring for a 24-year-old woman who is G1P0 at 40 weeks, 1 day gestation and in active labor. She has just received an epidural and now complains of "an itchy feeling all over." Her vitals are as follows: HR 120, RR 12, BP 130/74, T 98.8, and O2 sat 98% on room air. Which action should the nurse take first?

- Call the health care provider regarding the patient's pruritus to order and antipruritic med

The nurse is monitoring the fetal heart rate (FHR) tracing and sees that her patient has a tracing with a baseline of 120bpm, moderate variability, with absence of decelerations and accelerations. According to the National Institute of Child Health and Human Development five tier system, what category tracing does the patient's fall into?

- Category I tracing

A patient who is pregnant expresses a desire to attempt a vaginal delivery after a cesarean birth 2 years before. The primary care provider initiates trial of labor after cesarean (TOLAC) and vaginal birth after cesarean (VBAC) screening. The nurse is aware that which patient information will likely disqualify the patient for VBAC?

- Cesarean due to pelvic abnormalities

A neonate is born after 37 weeks gestation, and the nurse is concerned about avoiding cold stress after discharge. Which suggestions does the nurse give the mother to keep the baby safe? Select all that apply

- Change wet clothing immediately - Position baby away from vents and drafts - Place a stocking cap on neonates head - Keep baby wrapped in a warm blanket

A nurse-preceptor is explaining to a new nurse about the fetal heart monitoring. The new nurse is looking at the EFM paper and sees that, of the two tracked heart rates, the one on the bottom is in the 80s. The nurse is concerned that the fetal heart rate is bradycardic. Which of the following should the nurse do first?

- Check to make sure that the maternal radial pulse is being recorded correctly

The nurse works in a labor and delivery facility with new protocols for estimating postpartum blood loss. Which method for estimating blood loss is implemented in the delivery room?

- Collect blood in calibrated, under buttocks drape for vaginal birth

1. The nurse is providing care for a patient who is 8 hours postpartum after a vaginal delivery. The patient reports severe perineal pain unaffected by pain medication. The nurse notices a 4 cm area of discoloration on the labia that is tender to the touch. Which action does the nurse take after providing comfort measures?

- Contact primary care provider for futher eval

The nurse educates prenatal patients about the threat of TORCH infections. Which infections are included in this classification? (Select all that apply.)

- Cytomegalovirus - Toxoplasmosis - Rubella - Herpes Simplex

An internal fetal monitor (Scalp Electrode) has been ordered for Chrissy, a 24-year-old G2P0010 at 38 weeks and 1 day gestation. Her medical history is significant for a history of pregnancy-induced hypertension. Her laboratory values are as follows: H/H 11/30, O negative, RPR negative, GBS positive. Based on Chrissy's history and presentation, what action should the nurse take next?

- Discuss with the health care provider that Chrissy is GBS po and should not receive an internal monitor

The nurse is providing care for a neonate during the fourth stage of labor. Which action does the nurse take during this stage?

- Dry neonate immediately

The nurse is teaching a prenatal class. For which reason does the nurse emphasize the importance of managing maternal fear during labor?

- Dystocia is associated with extreme fear

When the nurse tells a pregnant woman that she needs 1200 mg of calcium daily during pregnancy, the woman responds, "I don't like milk." What dietary adjustments could the nurse recommend?

- Eat green leafy vegetables

The nurse educator is in a childbirth education class discussing nonpharmacological ways nurses can assist to enhance labor and spontaneous vaginal delivery. Which of the following facts regarding nonpharmacologic approaches will the nurse use to help illustrate its benefits?

- Effleurage is performed in rhythm with breathing during a contraction

The nurse is preparing a pregnant patient for an abdominal ultrasound at 8 weeks' gestation. What intervention will the nurse implement before this diagnostic test?

- Encourage the pt to drink 1 to 2 quarts of water before the test

A woman calls her health care provider to schedule prenatal visits in an uncomplicated pregnancy. How frequently will the nurse assist the patient to schedule these appointments?

- Every 4 weeks until the 7th month, after which appointments will become more frequent

During the fourth stage of labor, which actions by the nurse will promote parent-newborn attachment? Select all that apply.

- Explain expected neonatal characteristics such as molding, milia, and lanugo - Initiate skin to skin with warm blanket - Delay administration of eye ointment until parents have held newborn

The nurse in a postpartum unit frequently teaches patients regarding breast care. Which teaching is most helpful to the breastfeeding patient? (Think Primary Engorgement)

- Express milk by a breast pump or manually

When meconium is present in the amniotic fluid at birth, the infant should be suctioned below the vocal cords before he or she takes her first breath.

- False naso/pharyngeal should be suctioned

At birth, an indirect Coombs' test is performed on the newborn's cord blood to determine if the fetus has produced antibodies to his or her mother's blood.

- False- direct combs test determines antibody production

An extremely low-birth weight infant is one whose weight is 2000 g or less.

- False- extremely low is 1,000g or less

A patient who is at 39 weeks gestation is scheduled for amniotomy. The nurse is aware that which criteria must be met before the procedure?

- Fetal head is currently engaged in the maternal pelvis (ischial spines)

The nurse is preparing a postpartum patient for discharge. For which reasons does the nurse instruct the patient to call the primary care provider? Select all that apply.

- Foul-smelling lochia - Hot, red, painful breasts, frequent, painful urination

The nurse emphasizes to a patient with a high-risk pregnancy that the impact of such a pregnancy might result in which problems? (Select all that apply.)

- Frustration with activity restriction - Disruption of family roles - Financial pressures - Alteration in child care practices

The postpartum nurse is preparing to present infant care information to a couple who expresses concern about when to bathe their newborn. Which behaviors will the nurse present as general guidelines? Select all that apply.

- Genital and rectal areas should be cleaned after each diaper change - Avoid use of soap on newborn's face - Daily bathing with soap is not necessary for the newborn - Use mild preservative-free soap with a neutral PH

The nurse is reviewing the chart of a 35-year-old G4P2012 woman. The patient is at 38 weeks, 4 days and is in active labor with SROM (spontaneous rupture of membranes) 2 hours ago, with clear fluid. What action should the nurse take

- Help the patient change her position from side to side every 30 mins

The nurse is preparing for the discharge of a neonate diagnosed with a congenital breathing disorder. Which health team members does the nurse include in discharge planning? Select all that apply.

- Home health agency nurse - Respiratory therapy - Case manager - Social worker

A pregnant patient tells the nurse that she has been nauseated and vomiting. How will the nurse explain that hyperemesis gravidarum is distinguished from morning sickness?

- Hyperemesis gravidarum causes dehydration and electrolyte imbalances

A pregnant woman states, "My husband hopes I will give him a boy because we have three girls." What will the nurse explain to this woman?

- If a sperm carrying the Y chromosome fertilizes the ovum, a boy is produced

The nurse is providing care for a patient who is 1 day postpartum and exhibiting symptoms of postpartum psychosis. Which medical management does the nurse expect for this patient?

- Immediate hospitalization in a psychiatric ward

The nurse is preparing discharge teaching for a postpartum patient who exhibits signs and symptoms of an episiotomy infection and is on oral antibiotic therapy. Which discharge teaching will the nurse provide regarding pain management?

- Information applicable to medication therapy

The nurse is providing care for a neonate born to a mother with preexisting diabetes mellitus. Which neonatal assessment findings do the nurse expect? Select all that apply.

- Macrosomia - Jaundice - Dyspnea - Hypocalcemia

The nurse is providing care for a premature neonate in the NICU nursery. The neonate is diagnosed with bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA). Which specific intervention does the nurse expect for this neonate?

- Maintain fluid restrictions

What are the functions of amniotic fluid? (Select all that apply.)

- Maintaining even temp - Acting as a cushion for the fetus

A patient who is 30 weeks pregnant delivers a stillborn child in the emergency department (ED). What should the ED nurse offer the patient? (Select all that apply)

- Materials about support groups - A memento - Opportunity to hold infant - Privacy

The nurse is assisting the primary care provider with the third stage of a vaginal delivery. The patient is multiparous, experienced a precipitous birth, and has a history of hypertension. Which medical prescription does the nurse anticipate for this patient?

- Methylergonovine (Mathergine)

The neonatal nurse understands that some neonates spontaneously take a breath once the head and chest is delivered. Which understanding does the nurse have for the neonate that requires chemical stimuli to breathe?

- Mild hypoxia and decreased PH stimulates the brain

The nurse is providing care for a patient in the second stage of labor (pushing stage). After more than 4 hours of pushing, the nurse suspects fetal dystocia. Which is the GREATEST risk to the fetus related to the nurse's suspected complication?

- Neonatal asphyxia related to prolonged labor

The postpartum nurse notices that a new mother has her neonate unwrapped and undressed "to check out the baby." Which neonatal action indicates to the nurse that the neonate is at risk for cold stress?

- Neonate is moving extremities about

The nurse works in a postnatal nursery and is required by hospital policy to perform a gestational age assessment on specified neonates. On which neonate is the nurse most likely to perform this assessment?

- Neonate with a birth weight if 4,100g

When preparing to teach a class about prenatal development, the nurse would include information about folic acid supplementation. What is folic acid known to prevent?

- Neural tube defects!!!

The nurse is reviewing fetal circulation with a pregnant patient and explains that blood circulates through the placenta to the fetus. What vessel(s) carry blood to the fetus?

- One umbilical vein

The EFM tracing shows the following: FHR baseline 166 bpm, moderate variability, and recurrent late decelerations to 100 bpm. Using the five-tier FHR interpretation system, how should the nurse interpret this tracing?

- Orange; acceptable low risk of acidemia, prepare for possible urgent delivery

The nurse is providing care for a premature neonate born at 28 weeks gestation who is experiencing respiratory distress syndrome (RDS). Which assessment finding indicates to the nurse that the neonate's respiratory status is deteriorating?

- PaO2 is 48 and PaCO2 is 55mmHg on 90% oxygen

The nurse is concerned about the number of infants in the community who die from SIDS even with teaching about "back to sleep" being provided. On which additional preventive measures will the nurse focus? Select all that apply.

- Parents should not smoke or allow smoking around their baby - Infants need to be dressed to prevent infants from overheating - Mothers need to be informed that breastfeeding reduces risk for SIDS - During pregnancy, women should not smoke, drink alcohol, or use illegal drugs - Parents need to avoid products that claim to reduce the risk of SIDS

A new mother expresses severe frustration with an infant that is exhibiting symptoms of colic. Which suggestions from the nurse are aimed at infant safety? Select all that apply.

- Place baby in a safe place and allow baby to cry for 10-15 mins - Do simple household chores, such as vacuuming for washing the dishes

While providing care for a patient (the patient is moving around), the nurse notices an erratic FHR recording. What action should the nurse take next?

- Place the transducer in a different position

A postpartum patient informs the nurse of a frequent urge and burning when attempting to urinate. The nurse reviews the patient's medical record and associates which risk factors related to a possible urinary tract infection (UTI)? Select all that apply.

- Poor oral fluid intake - Use of vacuum extractor - Urinary cath during labor - Neonatal macrosomia

The nurse is providing education about postpartum depression. How does the nurse differentiate baby blues from postpartum depression?

- Postpartum depression usually happens after discharge where a patient has more bad days than good

The nurse is obtaining history and physical information on a new patient attending her first prenatal visit. After recording current height, weight, and BMI, it is determined that the patient is obese. What complications related to obesity will the nurse assess this patient for during pregnancy? (Select all that apply.)

- Pre-eclampsia - HTN - Gestational diabetes

A woman asks the nurse, "How do oral contraceptives prevent pregnancy?" What will the nurse explain about the combination of estrogen and progesterone in oral contraceptives?

- Prevents ovulation

The labor and delivery nurse is present for the delivery of a premature neonate. Which action by the nurse is most important?

- Provide a neutral thermal environment

A woman, gravida 3, para 2, is attending her fourth prenatal visit and confides in the nurse that she is battered by her husband. She is assessed to have multiple bruises at various stages of healing. What nursing actions are appropriate for the nurse to implement? (Select all that apply.)

- Provide privacy for the assessment -Determine factors that increase the risk of injury - Determine if children are being hurt - Communicate in a nonjudgmental way

The nurse is reviewing the medical record for a patient who is postpartum. The nurse notices the patient is rubella-nonimmune. Which information does the nurse present to the patient? Select all that apply.

- Pt will need to be immunized before discharge - Risks to the fetuses of any future pregnancies - Pregnancy should be avoided for 4 weeks

In a routine prenatal visit, the nurse examining a patient who is 37 weeks pregnant notices that the fetal heart rate (FHR) has dropped to 120 beats/minute from a rate of 160 beats/minute earlier in the pregnancy. What is the nurse's first action?

- Record rate as normal finding

What situation would concern the nurse about the presence of Rh incompatibility?

- Rh-neg mother, Rh pos fetus

A patient who is at 41 weeks gestation is concerned when the primary care provider decides to induce labor. Which reason does the nurse explain as the most important need for this procedure?

- Risk for placental dysfunction

The nurse is preparing a postpartum patient for discharge. Which patient teaching is most important for the nurse to provide?

- S/S of secondary hemorrhage

A woman who is 37 weeks pregnant reports feeling dizzy when lying on her back. What does the nurse explain as the most likely cause of this symptom?

- Supine hypotension syndrome

The nurse is collecting information during a follow-up OB appointment with a patient who delivered 3 months ago. The patient reports her partner has become cynical, irritable, and verbally abusive. The nurse will screen for which risks related to paternal postnatal depression (PPND)? Select all that apply.

- The birth of his fourth child was unexpected and unplanned - The father is recently estranged from his parents/siblings - Father exhibited depression during the pregnancy

True labor is when......

- The cervix dilates

The nurse is providing care for a patient who is admitted for cervical ripening. The health care provider has prescribed the use of a hygroscopic dilator (Laminaria). Which conclusion is the nurse likely to draw from the prescribed method of cervical ripening?

- The method may be used for fetal demise

The nurse is looking at an EFM (external monitoring) strip and sees that the patient in active labor is having contractions that are every 10 minutes with mild intensity for the past 2 hours and the fetus is in fetal distress. What would this indicate for next steps?

- The patients' contractions are inadequate; the provider could consider and amnioinfusion through the IUPC, and once the fetus has improved, contractions need to be augmented to be more effective

The nurse is assisting the primary care provider with a vacuum-assisted delivery because of a prolonged second stage of labor. The nurse will inform the primary care provider when which guideline of the procedure is met?

- The three-pull rule method has been achieved

A mother who is breastfeeding expresses concern about whether her infant is getting enough milk. Which concrete indicator does the nurse provide to the mother?

- There are 6-8 wet diapers and several stools per day

The nurse is caring for a pregnant woman diagnosed with preeclampsia. What will the nurse explain is the objective of magnesium sulfate therapy for this patient?

- To prevent convulsions

The nurse is palpating a patient's uterus 12 hours after a vaginal delivery. For which reason does the nurse place one hand just above the symphysis pubis?

- To prevent uterine inversion

An ultrasound on a woman who is 32 weeks pregnant reveals the placenta implanted over the entire cervical os. What does the nurse understand best describes this condition?

- Total placenta previa

White, pimple-like spots on a newborns face is normal.

- True

The nurse is collecting information from a new mother who is bottle-feeding her infant. Which comment, made by the mother, requires the nurse to provide patient teaching?

- "sometimes I add a little water to the formula if I am running low"

A postpartum patient calls the OB office 8 days following a vaginal delivery. The patient reports concern regarding vaginal bleeding. Which patient-reported symptom causes the nurse concern?

- A description of the lochia being red in color

An ultrasound confirms that a 16-year-old girl is pregnant. How does the need for prenatal care and counseling for adolescents differ from other age populations?

- A pregnant adolescent is experiencing two major life transitions at the same time

A pregnant woman inquires about exercising during pregnancy. What information should the nurse include when planning to educate this woman?

- A regular schedule of moderate exercise during pregnancy is beneficial

A patient who is 12 hours postpartum after a vaginal delivery continues to have difficulty in initiating urination. The nurse is aware that an integrative method used when a woman is unable to void is peppermint oil. In which manner will the peppermint oil be used?

- A saturated cotton ball of peppermint is placed in a "hat" on the toilet

The nurse is present in the delivery room when a mother is told her neonate was stillborn. The mother begins to wail loudly and pull at her hair. Which action does the nurse take?

- Allow mother to express grief in her own way

A multiparous patient reports severe uterine cramps the first day after a vaginal delivery. The nurse is aware the patient is breastfeeding and associates the patient's pain primarily with which occurrence? (Think Physiologically)

- An increase in oxytocin release related to the newborn suckling

The nurse in NICU is assessing a neonate delivered at 32 weeks gestation. Which pathophysiological manifestation is the nurse's greatest concern?

- Apnea 20 seconds or longer

The nurse is assessing a newborn's reflexes. Which response will cause the nurse concern?

- Asymmetric moro reflex

Stage two labor is defined as?

- Complete cervical dilation and ends with delivery of baby

The premature neonate is more susceptible to skin breakdown than a term neonate. Which skin care interventions will the nurse implement for the premature neonate? Select all that apply.

- Use water, air, or gel mattress - Gently apply emollients to avoid unnecessary friction - Use a neutral PH cleanser and sterile water for bathing

Prior to discharge from the birthing center, the nurse informs the patient that she will receive vaccines for rubella, hepatitis B, pertussis, and influenza. For which reason does the nurse explain the need for the vaccinations?

- Vaccinating the mother will protect the neonate from serious illnesses

The nurse is preparing a talk with new parents about immunity and their newborns. Which factual information will the nurse present? Select all that apply.

- Vaccination is example of acquired immunity - Natural passive immunity protects the baby for a few months after birth - Placental transfer is how newborns ger natural passive immunity

What symptom presented by a pregnant women is indicative of abruptio placentae?

- Vaginal bleeding and back pain

After the examination is completed, the patient asks the nurse why Chadwick's sign occurs during pregnancy. What would the nurse explain as the cause of Chadwick's sign?

- Vascular congestion in the pelvic area

A patient delivers a term neonate and expresses concern about her neonate getting an injection. Which information from the nurse is accurate?

- Vitamin K is needed to activate clotting factors

The nurse is explaining telemetry to the patient, who has just begun active labor. The patient would like to have a labor in which she is mobile, able to change positions, and use hydrotherapy. Which response by the nurse is most appropriate?

- We can start using telemetry now and if there are no problems with the signal, we can continue it throughout your labor until delivery

The nursing is caring for a patient in active labor with significant back pain. The patient has requested nonpharmacologic methods of pain relief. The nurse thinks that sterile water injections may help with her pain management. Which of the following explanations should the nurse explain to the patient?

- We will inject .5 mL of sterile water SQ and it will last for an hour to 90 mins

What will the nurse begin with when asking a patient about drug use during a prenatal history?

- What over-the-counter and prescription drugs have you taken in the past 3 months

Which information is important for the nurse to provide to mothers of infants of 3 months of age regardless of the method of infant feeding?

- When growth spurts and dietary increases are expected

1. The nurse is reading the patient's chart, which indicates the patient has a "gynecoid pelvis." What finding is expected in this patient?

- Wider outlet

A woman pregnant for the first time asks the nurse, "When will I begin to feel the baby move?" What is the nurse's best response?

- You may notice the baby moving around the 4th or 5th month

At what point in prenatal development do the lungs begin to produce surfactant?

25 Weeks

A woman's prepregnant weight is determined to be average for her height. What will the nurse advise the woman regarding recommended weight gain during pregnancy?

25-35 lbs

The obstetric nurse is managing her laboring patients while covering for another nurse who is on a break. Which patient is the LOWEST priority?

A patient with a category I FHR tracing

What should a woman expect after insertion of an intrauterine device (IUD)?

A string should be felt in the vagina

A pregnant patient asks the nurse when her infant's heart will begin to pump blood. What will the nurse reply?

By the end of week 3

What is the most common site for fertilization?

Outer third of the fallopian tube near the ovary

What drug will the nurse plan to have available for immediate IV administration whenever magnesium sulfate is administered to a maternity patient?

Calcium gluconate

The nurse tells a woman who is trying to conceive to check her cervical mucus for changes. What will she expect the characteristic of cervical mucus to be a few days before ovulation?

Clear and Slippery

The nurse is providing support for the parents of a neonate born with anencephaly. The parents repeatedly state, "I don't believe this is happening to us. We were so careful during pregnancy." The nurse associates the parents' comments with which stage of grief?

Disbelief

During an ultrasound, two amnions and two placentas are observed. What will be the most likely result of this pregnancy

Dizygotic Twins

A woman tells the nurse that she is quite sure she is pregnant. The nurse recognizes which as a positive sign of pregnancy?

Fetal heartbeat

A woman who is 7 weeks pregnant tells the nurse that this is not her first pregnancy. She has a 2-year-old son and had one previous spontaneous abortion. How would the nurse document the patient's obstetric history using the TPALM system?

Gravida 3, para 10110

A pregnant woman is experiencing nausea in the early morning. What recommendations would the nurse offer to alleviate this symptom?

Have crackers handy at the bedside, and eat a few before getting out of bed.

A woman is 9 weeks pregnant and experiencing heavy bleeding and cramping. She reports passing some tissue. Cervical dilation is noted on examination. What is the most likely cause of these symptoms?

Incomplete abortion

A pregnant woman is attending her second prenatal visit. Prenatal lab work indicates she is not immune to the rubella virus. What is the most appropriate nursing intervention?

Inform the woman she should receive the vaccine in the hospital after delivery

The nurse is providing support to a mother whose newborn is diagnosed with a life-threatening defect. The mother states, "I just want to go home and never come back." Which reaction by the mother does the nurse recognize?

Maternal emotional distancing

A woman reports that her last normal menstrual period began on August 5, 2013. What is this woman's expected delivery date using Nägele's rule?

May 12, 2014- subtract 3 months, add 7 days

The nursing preceptor asks the nursing student how to best determine the intensity of contractions before placing the patient on an electronic fetal monitoring system. How would the nurse assess this?

Palpate the abdomen during contractions

The nursing is caring for a 31-year-old female patient who is pregnant at 37 weeks and 5 days gestation. The patient is having contractions every 3 minutes and was found to have a platypelloid pelvis upon examination. The fetus has an estimated fetal weight of 7 lbs and is in the LOA position. This patient is laboring on the birth ball, and her mother-in-law is helping her labor. The nurse is concerned about the five Ps and their effect on the patient's labor. Which P is the nurse most likely concerned about based on the patient's history?

Passage

The nurse recognizes which behavior characteristic(s) of women in their first trimester of pregnancy? (Select all that apply.)

Showing off her sonogram photos Fatigue Ambivalence about pregnancy Emotional and labile mood

The nurse assesses a pregnant woman for pregnancy-induced hypertension. What is the first sign of fluid retention suggestive of this complication?

Sudden weight gain

The patient who is 28 weeks pregnant shows a 10-pound weight gain from 2 weeks ago. What is the nurse's initial action?

Take BP

The school nurse is counseling a group of adolescent girls. What does the nurse explain about sperm ejaculated near the cervix?

They survive up to 5 days and can cause pregnancy.

A newborns normal heart rate is 110-160 bpm and respiratory rate is 30-60 bpm.

True

1. The nurse is using the five-tier system fetal heart system. A co-worker is concerned about a patient whose fetus has an acceptably low risk of acidemia but evidence of impending fetal asphyxia (orange color). What is the next best step for the nurse?

prepare for possible urgent delivery