OB FINAL EXAM REVIEW

A nurse is caring for a client who is at 39 weeks gestation and is in active labor. The nurse locates the fetal heart tones above the clients umbilicus at midline. The nurse should suspect that the fetus is in which of the following positions? A. Cephalic. B. Transverse. C. Posterior. D. Breech.

D. Breech

A nurse is caring for a client who is breastfeeding and states that her nipples are sore. Which of the following interventions should the nurse suggest? A. Apply mineral oil to the nipples between feedings B. Keep the nipples covered between breastfeeding sessions C. Increase the length of time between feedings D. Change the newborn's position on the nipples with each feeding.

D. Change the newborn's position on the nipples with each feeding.

A nurse is caring for a client who is 12 hr postpartum. Which of the following findings should alert the nurse to the possibility of a postpartum complication? A. Orthostatic hypotension B. Fundus palpable at the umbilicus C. Urine output of 3,000 mL in 12 hr D. Heart rate 110/min

D. Heart rate 110/min

A nurse is caring for a newborn whose mother is positive for the hepatitis B surface antigen. Which of the following should the infant receive? A. Hepatitis B immune globulin at 1 week followed by hepatitis B vaccine monthly for 6 months B. Hepatitis B vaccine monthly until the newborn test negative for the hepatitis B surface antigen C. Hepatitis B immune globulin and hepatitis B vaccine with 12 hours of birth D. Hepatitis B vaccine at 24 hours followed by hepatitis B immune globulin every 12 hours for 3 days

D. Hepatitis B vaccine at 24 hours followed by hepatitis B immune globulin every 12 hours for 3 days

A client states their breast are starting to feel sore after breast feeding their infant. Upon inspection the nurse notices the nipple is cracked. What is this client at risk for developing? A. Breast Engorgement B. Breast Cancer C. Fibrocystic Breasts D. Mastitis

D. Mastitis

A nurse is caring for a client who has just delivered a newborn. The nurse note secretions bubbling out of the newborn's nose and mouth. Which of the following actions is the nurse's priority? A. Turn the newborn on his side B. Use a suction catheter with low negative pressure C. Suction the nose with a bulb syringe D. Suction the mouth with a bulb syringe

D. Suction the mouth with a bulb syringe

A nurse is caring for an antepartum client whose laboratory findings indicate a negative rubella titer. Which of the following is the correct interpretation of this data? A. The client is not experiencing a rubella infection at thisterm-20 time. B. The client is immune to the rubella virus. C. The client requires a rubella vaccination at this time. D. The client requires a rubella immunization following delivery.

D. The client requires a rubella immunization following delivery. - A negative rubella titer indicates that the client is susceptible to the rubella virus and needs vaccination following delivery. Immunization during pregnancy is contraindicated because of possible injury to the developing fetus. Following rubella immunization, the client should be cautioned not to conceive for 1 month.

A nurse is assessing a postpartum client who is exhibiting tearfulness, insomnia, lack of appetite, and a feeling of letdown. Which of the following conditions are associated with these manifestations? A. postpartum fatigue B. postpartum psychosis C. Letting-go phase D. postpartum blues

D. postpartum blues

Triage nurse is reviewing the open record of a client who is 32 weeks of gestation the client reports having a spontaneous miscarriage at 13 weeks to station six years ago delivered a baby girl 36 weeks gestation a baby boy a 40 weeks gestation and baby girl 39 weeks gestation how would you document? what is the GTPAL?

G4 T2 P1 A1 L3 32 week pregnant 6 months prior had a spontaneous miscarriage at 13 weeks Has had a 36 week child delivery Preterm 40 wk child delivery—Term 39 week child delivery—Term

GTPAL question, how should the nurse interpret this? G3 T1 P1 A0 L2

"I've been pregnant 3 times, including this current pregnancy"

What are the components in biophysical assessment?

- fetal breathing - fetal motion - fetal tone - amniotic fluid volume - FHR

What are the signs of impending labor?

- lightening - braxton hicks - cervical changes - losing the mucus plug - increase in vaginal discharge - nesting --> burst of energy to put everything in order - urge to poop

HR = 112, weak cry, some grimace, blue extremities and pink body, some flexion. what is the APGAR score?

6

What Are Some Risk Factors for Cervical Cancer? (Select all the apply) A. Genital HPV Infection B. Cigarette Smoking C. Nasal fLaring D. Early Contraceptive Use E. All of the above

A, B, D

A nurse is caring for a client who is undergoing a BPP. The clients asks the nurse what is being evaluated during this test. Which of the following should the nurse include? SATA A. fetal breathing B. fetal motion C. Fetal neck translucency D. amniotic fluid volume E. FHR

A, B, D, E

A nurse is caring for a newborn delivered by vaginal birth with a vacuum assist. The newborn's mother asks about the swollen area on her son's head. After palpation to identify that the swelling crosses the suture line, which of the following is an appropriate response by the nurse? A. "A caput succedaneum occurs due to compression of blood vessels." B. "Mongolian spots can be found on the skin of many newborns." C. "This is a cephalohematoma, which can occur spontaneously." D. "This is erythema toxicum, which is a transient condition."

A. "A caput succedaneum occurs due to compression of blood vessels."

A nurse is providing teaching about phenylketonuria (PKU) testing to the parent of a newborn. Which of the following statements by the parent indicates a need for additional teaching? A. "My baby will be placed under special lights if the test result is positive." B. "My baby needs to be on formula or breast milk before the test can be done." C. "This test checks for a genetic disorder that can be managed by diet." D. "Sometimes the test is repeated in the doctor's office at the baby's 2-week check-up."

A. "My baby will be placed under special lights if the test result is positive."

A nurse is assesing a newborn 6 hours after birth and noticed jaundice. What could be the cause of this jaundice? A. RH incompatibility B. physiological jaundice C. hypoxia D. hypertension

A. RH incompatibility

A nurse is caring for a client who is in labor and has an external fetal monitor. The nurse observes variable decelerations on the monitor strip and interprets them as indicating which of the following? A. Umbilical cord compression B. Maternal bradycardia C. Uteroplacental insufficiency D. Fetal head compression

A. Umbilical cord compression

What nursing diagnosis would be the most appropriate for a woman experiencing severe preeclampsia? a. Risk for injury to the fetus related to uteroplacental insufficiency. b. Risk for eclampsia. c. Risk for increased cardiac output related to use of antihypertensive drugs.

ANS: A Risk for injury to the fetus related to uteroplacental insufficiency - Other diagnoses include risk to fetus related to preterm birth and abruptio placentae. Eclampsia is a medical, not a nursing, diagnosis. There would be a risk for decreased, not increased, cardiac output related to the use of antihypertensive drugs.

A nurse is caring for a postpartum client who delivered their third infant 2 days ago. Which of the following manifestations could indicate postpartum depression? (Select all that apply.) A. Fatigue B. Insomnia C. Euphoria D. Flat affect E. Delusions

ANS: A, B, D - fatigue - insomnia - flat affect

A nurse is caring for a client who is a primigravida, at term, and having contractions but is stating that she is "not really sure if she is in labor or not." Which of the following should the nurse recognize as a sign of true labor? A. Rupture of the membranes B. Changes in the cervix C. Station of the presenting part D. Pattern of contractions

ANS: B. Changes in the cervix - Assessment of progressive changes in the effacement and dilation of the cervix is the most accurate indication of true labor. INCORRECT: A. The membranes can rupture spontaneously long before the onset of labor. C. A client who is a primigravida will typically engage before labor and can enter labor at -1, 0, or even +1 station. D. A client can have regular contractions for a significant period of time prior to the onset of true labor

A nurse is caring for a client who is 37 wks and in active labor and laying in a supine position, the bp reads 82/56. Which intervention should the nurse perform first?

Assist client to lateral position

What are the classifications of preterm birth? (Select all that apply) A. Early preterm: born at 20-25 weeks gestation  B. Very premature: born at less than 32 weeks of gestation C. Moderately premature: born between 32 and 33 completed weeks of gestation D. Late premature: born between 34-36 completed weeks of gestation  E. All of the above

B, C, D

What is the most common STI among pregnant women in the United States? A. Gonorrhea B. Chlamydia C. Syphilis D. Trichomoniasis

B. Chlamydia

A nurse is caring for a newborn immediately following birth. After assuring a patent airway, what is the priority nursing action? A. Administer vitamin K B. Dry the skin C. Administer eye prophylaxis D. Place an identification bracelet

B. Dry the skin

A nurse in the prenatal clinic is caring for a client who is suspected of having a hydatidiform molar pregnancy. Which of the following findings should the nurse expect to observe in this client? A. Rapid decline in human chorionic gonadotropin (hCG) levels B. Excessive uterine enlargement C. Irregular fetal heart rate. D. Profuse, clear vaginal discharge.

B. Excessive uterine enlargement

A nurse is completing a health history for a client who is at 6 weeks of gestation. The client informs the nurse that she smokes one pack of cigarettes per day. The nurse should advise the client that smoking places the client's newborn at risk for which of the following complications? A. Hearing loss B. Intrauterine growth restriction C. Type 1 diabetes mellitus D. Congenital heart defects

B. Intrauterine growth restriction - Clients who smoke place their newborns and themselves at risk for diverse complications, including fetal intrauterine growth restriction, placental abruption, placenta previa, preterm delivery, and fetal death.

A nurse is caring for a client who is 2 hr PP. The nurse notes the client's perineal pad has a large amount of lochia rubra w/ several clots. Which of the following actions should the nurse perform first? A. Check for full bladder B. Massage the fundus C. Measure blood pressure D. Administer carboprost IM

B. Massage the fundus

A nurse is completing a newborn assessment and observes small pearly white nodules on the nose and chin. This finding is a characteristic of which of the following conditions? A. Mongolian spots B. Milia spots C. Erythema toxicum D. Epstein's pearls

B. Milia spots

A nurse is caring for a newborn and observes signs of diaphoresis, jitteriness, and lethargy. Which of the following actions should the nurse take? A. Place the newborn under a radiant warmer B. Obtain blood glucose by heel stick C. Monitor the newborn's blood pressure D. Initiate phototherapy

B. Obtain blood glucose by heel stick

A client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing which condition? A. Rupture of the bladder B. The development of a vesico vaginal fistula C. Extreme stress caused by the diagnosis of cancer D. Altered perineal sensation as a side effect of radiation therapy

B. The development of a vesico vaginal fistula A vesicovaginal fistula is a genital fistula that occurs between the bladder and vagina. The fistula is an abnormal opening between these two body parts and, if this occurs, the client may experience drainage of urine through the vagina.

Which of the following foods should you include to prevent constipation? A. lean meat B. apple C. hot dog D. milk

B. apple

A nurse is reinforcing teaching about newborn care with a postpartum client. Which of the following statements by the client indicates a need for further teaching? A. "I will use mild soap." B. "I will use a basin during bathing." C. "Baby powder will help prevent a diaper rash." D. "I will test the water on my wrist for temperature before bathing."

C. "Baby powder will help prevent a diaper rash."

A nurse is assessing a client for postpartum infection. Which of the following findings should indicate to the nurse that the client requires further evaluation for endometritis? A. Moderate amount of dark red lochia with a bloody odor B. A localized area of breast tenderness C. Pelvic pain D. Hematuria

C. Pelvic pain

A nurse is assessing a newborn for manifestations of a large patent ductus arteriosus (PDA). Which of the following findings should the nurse expect? A. Cyanosis with crying B. Weak pulses C. Systolic murmur D. Chronic hypoxemia

C. Systolic murmur

A pregnant client expresses a strong desire to attempt a vaginal delivery after her last delivery resulting in C-section the primary provider is aware that which the following will disqualify this client to attempt a VBAC?

Classical vertical uterine incision

A laboring client with a history of gestational diabetes is pushing. As the fetal shoulder becomes impacted under the maternal symphysis pubis. What maneuver should the nurse initiate?

McRobert's maneuver

precipitous labor is at risk for

PPH

What are the 5 P's?

Powers Passage Passenger Psyche Position

What does betamethasone do?

accelerates fetal lung maturity

A nurse is completing an assessment. Which of the following data indicate the newborn is adapting to extrauterine life?

apnea for 10 second periods - Periods of apnea lasting less than 15 seconds are an expected finding.

A nurse is caring for a client who reports unrelieved episiotomy pain 12 hours following a vaginal birth. Which action should the nurse take?

apply an ice pack to the affected area

fontanelle is dehydrated, what does this mean

depressed fontanelle

Which layer contains esophagus, stomach, and intestine?

endoderm - think of endo as inside

Placenta accreta/increta/percreta

endometrium, myometrium, entire accreta: Invasion of the trophoblast is beyond the normal boundary without invasion of the decidua increta: Invasion of the trophoblast extends into the uterine myometrium percreta: Invasion of the trophoblast extends into the uterine musculature and can adhere to other pelvic organs

A nurse is providing preconception counseling for a client who is planning a pregnancy. Which of the following supplements should the nurse recommend to help prevent neural tube defects in the fetus?

folic acid

A nurse is reviewing the electronic FHR strip and notes the variability pattern which indicates the fetus has an intact central nervous system?

moderate variability

What does tachysystole mean?

more than 5 uterine contractions within 10 mins

During preconception counseling the nurse explains that during the first eight weeks the fetus is not vulnerable to the effects of teratogens what is occurring?

organogenesis

how can we prevent conduction?

place the baby in a warmer surface

How do you assess for tonic neck reflex?

quickly and gently turn the newborn's head to one side when the newborn is sleeping or falling asleep

What does REEDA stand for

redness edema ecchymosis discharge approximation

What is the purpose of methergine?

to prevent PPH

How much blood plasma volume is increased during pregnancy?

30 - 45%

A nurse is teaching about fetal development to a group of clients in the antenatal clinic. Which of the following statements should the nurse include in the teaching? A. "The baby's heart beat is audible by a Doppler stethoscope at 12 weeks of pregnancy." B. "The sex of the baby is determined by week 8 of pregnancy." C. "Very fine hairs, called lanugo, cover your baby's entire body by week 36 of pregnancy." D. "You will first feel your baby move in week 24 of pregnancy."

A. "The baby's heart beat is audible by a Doppler stethoscope at 12 weeks of pregnancy." - The fetal heartbeat is audible by Doppler stethoscope between 8 to 17 weeks of gestation.

A nurse is caring for a client who is at 38 weeks of gestation and reports no fetal movement for 24 hr. Which of the following actions should the nurse take? A. Auscultate for a FHR B. have the client drink orange juice C. Reassure the client that a term fetus is less active D. palpate the uterus for fetal movement

A. Auscultate for a FHR Presence of a fetal heart rate is a reassuring manifestation of fetal well-being. The nurse should auscultate for the fetal heart rate using a Doppler device or an external fetal monitor. This is the priority nursing action.

A nurse in the L &D unit is caring for a client who is undergoing external fetal monitoring. The nurse observes the FHR begins to slow at the start of a contraction and with the return to the FHR baseline at the end of the contraction. The nurse should document this finding as which of the following? A. Early decelerations B. Late decelerations C. Accelerations D. Variable decelerations

A. Early decelerations

A nurse is instructing a female client about how to check basal temperature in order to determine if the client is ovulating. The nurse should instruct the client to check her temperature at which of the following times? A. Every morning before arising. B. On days 13 to 17 of her menstrual cycle. C. 1 hour following intercourse. D. Before going to bed every night.

A. Every morning before arising.

A nurse is assessing a patient who has been diagnosed with polycystic ovary syndrome. What finding should the nurse expect to find? A. Excess hair on the body B. easily fertile C. weight loss/ anorexic D. dry skin

A. Excess hair on the body

A nurse is caring for a client who is postpartum and received methylergonovine. Which of the following findings indicates that the medication was effective? A. Fundus firm to palpation B. Increase in blood pressure C. Increase in lochia D. Report of absent breast pain

A. Fundus firm to palpation

A client is receiving 4th block anesthesia. Which of the following anesthetic should the patient get? A. epidural B. spinal C. pudendal D. paracervical

A. epidural - Consists of a local anesthetic, bupivacaine, along with an analgesic, morphine or fentanyl, injected into the epidural space at the level of the 4th or 5th vertebrae

What is included in the physical maturity assessment in the New Ballard scale? SATA A. posture B. arm recoil C. leg recoil D. heel to forehead E. square window F. scarf sign

A. posture B. arm recoil E. square window F. scarf sign

A nurse in a prenatal clinic is caring for a client who is pregnant and experiencing episodes of maternal hypotension, dizziness, and fainting. The client asks the nurse what causes these episodes. Which of the following responses should the nurse make? A. "This is due to an increase in blood volume." B. "This is due to pressure from the uterus on the diaphragm." C. "This is due to the weight of the uterus on the vena cava." D. "This is due to increased cardiac output."

C. "This is due to the weight of the uterus on the vena cava." - Maternal hypotension occurs when the client is lying in the supine position and the weight of the gravid uterus places pressure on the vena cava, decreasing venous blood flow to the heart.

A nurse is completing discharge instructions for a new mother and her 2-day old newborn. The mother asks, "How will I know if my baby is getting enough breast milk?" Which of the following responses should the nurse make? A. "Your baby should sleep at least 6 hours between feedings." B. "Your baby should burp after each feeding." C. "Your baby should wet 6 to 8 diapers per day." D. "Your baby should have a wake cycle of 30-60 minutes after each feeding."

C. "Your baby should wet 6 to 8 diapers per day."

A nurse is reviewing car seat safety with the parents of a newborn. Which of the following instructions should the nurse include in the teaching regarding car seat position? A. Front seat, rear-facing B. Front seat, forward-facing C. Back seat, rear-facing D. Back seat, forward-facing

C. Back seat, rear-facing

A nurse is caring for a client who is 7 days postpartum and calls the clinic to report pain and redness of her left calf. Besides seeing her provider, which of the following interventions should the nurse suggest? A. Flex her knee while resting. B. Massage the area. C. Elevate her leg. D. Apply cold compresses

C. Elevate her leg

A nurse is caring for a newborn 4 hrs after birth. Which of the following actions should the nurse include in the plan of care to prevent jaundice? A. Begin phototherapy B. Suction excess mucus with a bulb syringe C. Initiate early feeding D. Prepare for an exchange blood transfusion

C. Initiate early feeding

A nurse is caring for a client who is gravida 3, para 2, and is in active labor. The fetal head is at 3+ station after a vaginal examination. Which of the following actions should the nurse take? A. Apply fundal pressure. B. Observe for the presence of a nuchal cord. C. Observe for crowning. D. Prepare to administer oxytocin.

C. Observe for crowning. - In the descent phase of the second stage of labor, crowning occurs when the fetal head is at +2 to +4 station. Because this is the client's third childbirth experience, it is reasonable to assume that delivery is imminent.

A nurse is caring for a client who is having a nonstress test performed. The FHR is 130 to 150 bpm, but there has been no fetal movement for 15 min. Which of the following is an appropriate nursing intervention? A. Immediately report the situation to the client's provider and prepare the client for induction of labor B. Encourage the client to walk around without the monitoring unit for 10 min, then resume monitoring C. Offer the client a snack of orange juice and crackers D. Turn the client on her left side

C. Offer the client a snack of orange juice and crackers - This fetus is most likely asleep. Most fetuses are more active after meals due to the increase in the mother's blood sugar. Giving the mom a snack will promote fetal movement

A nurse is assessing a female client who states that she is experiencing fatigue, pain in her arm, and shortness of breath with mild chest discomfort. Which of the following laboratory tests should the nurse anticipate the provider to prescribe? A. AST & ALT B. BNP C. Troponin I D. LDL

C. Troponin I

A nurse in labor and delivery is caring for a client. Following delivery of the placenta, the nurse examines the umbilical cord. Which of the following vessels should the nurse expect to observe in the umbilical cord? A. Two veins and one artery B. One artery and one vein C. Two arteries and one vein D. Two arteries and two veins

C. Two arteries and one vein - The vein carried the oxygenated, nutrient-rich blood from the placenta to the fetus, and the two arteries returned the blood to the placenta.

A nurse is caring for a client who has a suspected ectopic pregnancy at 8 weeks of gestation. Which of thefollowing manifestations should the nurse expect to identify as consistent with the diagnosis? A. Severe nausea and vomiting B. Large amount of vaginal bleeding. C. Unilateral, cramp-like abdominal pain D. Uterine enlargement greater than expected for gestational age

C. Unilateral, cramp-like abdominal pain Rationale: An ectopic pregnancy is one in which the fertilized egg implants in tissue outside of the uterus and the placenta and fetus begin to develop in this area. The most common site is within a fallopian tube; however, ectopic pregnancies can occur in the ovary, the abdomen, and in the cervix.

A nurse is caring for a client who has a Positive pregnancy test. The nurse is teaching the client about the warning signs of potential danger. The nurses should instruct the client to call the office if she experiences one of the following manifestations: A. nausea B. leukorrhea C. abdominal pain D. urinary frequency

C. abdominal pain

A nurse is caring for a client with GD who is having a non-stress test performed. The fetal heart rate is 130-150/min. but there has been no fetal movement for 15 minutes. Which of the following actions should the nurse perform? A. give them juice B. ice cold water C. perform a VAS

C. perform a VAS

A nurse is teaching a newborn's parent to care for the umbilical cord stump. Which of the following instructions should the nurse include? A. Wash the cord daily with soap and water. B. Cover the cord with the diaper. C. Apply petroleum jelly to the cord stump. D. Give a sponge bath until the cord falls off

D. Give a sponge bath until the cord falls off

A nurse is educating a patient during her initial prenatal care visit during her 1st trimester. She is educating her about Healthy People 2030 and what trends are worsening since 2018. What comment by the patient demonstrates an understanding of the teaching? Select all that apply. A) "I don't have to worry about Syphilis as much since it's getting better." b) "The cases of abortion and miscarriage are decreasing." c) "I don't need to receive early and adequate prenatal care." d) "The rate at which pregnant women abstain from smoking are decreasing."

b) "The cases of abortion and miscarriage are decreasing." d) "The rate at which pregnant women abstain from smoking are decreasing."

Through a vaginal examination, the nurse determines that a woman is 4 cm dilated. The external fetal monitor shows uterine contractions every to 4 minutes. The nurse reports this as what stage of labor? a. First stage, latent phase b. First stage, active phase c. First stage, transition phase d. Second stage, latent phase

b. First stage, active phase - This maternal progress indicates that the woman is in the active phase of the first stage of labor. During the latent phase of the first stage of labor, the expected maternal progress is 0 to 3 cm dilation with contractions every 5 to 30 minutes. During the transition phase of the first stage of labor, the expected maternal progress is 8 to 10 cm dilation with contractions every 2 to 3 minutes. During the latent phase of the second stage of labor, the woman is completely dilated and experiences a restful period of "laboring down."

A nurse is caring for a client who is postpartum and has a prescription for Rho (D) immunoglobulin. The nurse should verify which of the following prior to administration?

client is Rh negative (Rh-) and the newborn is Rh positive (Rh+)

A nurse is caring for a newborn baby who just had circumcision. What should the nurse include in her teaching with post-op care?

report the lack of voiding

A client received a prescription from her provider for Clomiphene Citrate what is the primary action?

stimulates the release of FSH and LH, which stimulates ovulation

a patient is showing signs of magnesium toxicity, what should you do first?

stop the infusion of magnesium sulfate

An active labor is experiencing utero contractions that are every minute for the last 10 minutes and the FHR is dropping and does not appear to be coming back up. After you repositioned the client and applied oxygen, which med would you administer?

terbutaline

The nurse educator is teaching a class on fetal development what should the nurse include as the most important function of the placenta?

the placenta provides metabolic in gas exchange