Test 3 for OB practice

A pregnant client arrives on the birthing unit from the emergency department with frank blood running down both legs and a reported low blood pressure. What is the priority nursing intervention? Assessing fetal heart tones Assessing for a prolapsed cord Starting an intravenous (IV) infusion Inserting a uterine pressure catheter

Assessing fetal heart tones

A client who is 21 weeks pregnant experiences a fetal loss because of an incompetent cervix. Once the client's physical needs have been assessed and met, what is the best way for the nurse to address the client's psychologic needs? Encouraging the client to see and hold the baby while still possible Taking photos and giving them to the client if she refuses to see the baby Sending the baby to the morgue as soon as possible and discouraging any contact Telling the client that the baby is decaying and it is probably for the best if the is client unsure about seeing the baby

Encouraging the client to see and hold the baby while still possible

What complication should a nurse be alert for in a client receiving an oxytocin infusion to induce labor? Intense pain Uterine tetany Hypoglycemia Umbilical cord prolapse

Uterine tetany

The nurse is assessing several postpartum clients at the very beginning of her shift. Which problem does the nurse identify that might predispose a client to postpartum hemorrhage? Preeclampsia Multifetal pregnancy Prolonged first-stage labor Cephalopelvic disproportion

Multifetal pregnancy

A newborn is admitted to the nursery. The newborn weighs 10 lb, 2 oz (4592 g), which is 2 lb (907 g) more than the birthweight of any of the neonate's siblings. Which intervention should the nurse implement in relation to this baby's birth weight? Document the findings Delay starting oral feedings Perform serial glucose readings Place the newborn in a heated crib

Perform serial glucose readings

The nurse is reviewing a client's history. Which two predisposing causes of puerperal (postpartum) infection should prompt the nurse to monitor this client closely? Malnutrition and anemia Hemorrhage and trauma during labor Preeclampsia and retention of placental fragments Organisms in the birth canal and trauma during labor

Hemorrhage and trauma during labor

A 36-year-old primigravida is receiving treatment for preeclampsia at 29 weeks' gestation. In light of the latest information on the client's record, which nursing intervention is of the highest importance at this time?

Notifying the primary healthcare provider regarding the epigastric pain, headache, and blurred vision

Which client is at increased risk for postpartum hemorrhage? One who breast-feeds in the birthing room One who receives a pudendal block for the birth One whose third stage lasts less than 10 minutes One who gives birth to an infant weighing 9 lb 8 oz (4366 g)

One who gives birth to an infant weighing 9 lb 8 oz (4366 g)

Which clinical finding should the nurse evaluate before continuing the administration of intravenous (IV) magnesium sulfate therapy? Temperature and respirations Patellar reflexes and urinary output Urinary glucose and specific gravity Level of consciousness and funduscopic appearance

Patellar reflexes and urinary output

The nurse determines that dietary teaching for a client with mild preeclampsia has been effective when the client makes which statement? "I should follow a diet that includes high sodium and calories and low protein." "I should follow a diet that includes low sodium and calories and high protein." "I should follow a diet that includes unrestricted sodium and lots of calories and protein." "I should follow a diet that includes moderate sodium and low calories with ample protein."

"I should follow a diet that includes unrestricted sodium and lots of calories and protein."

A client at 24 weeks' gestation arrives at the clinic for a routine examination. She tells the nurse, "I feel puffy all over." In light of this statement, what is the nurse's most important assessment? Obtaining her blood pressure Determining how much salt she uses Asking the extent of her daily fluid intake Reviewing her history for total weight gain

Obtaining her blood pressure

Which information in a postpartum client's health history should alert the nurse to monitor the client for signs of infection? Three spontaneous abortions B-negative maternal blood type Blood loss of 850 mL after a vaginal birth Temperature of 99.9° F (37.7° C) during the first postpartum day

Blood loss of 850 mL after a vaginal birth

An infant is admitted to the nursery after a difficult shoulder dystocia vaginal birth. Which condition should the nurse carefully assess this newborn for? Facial paralysis Cephalhematoma Brachial plexus injury Spinal cord syndrome

Brachial plexus injury

A client who is in labor is admitted 30 hours after her membranes ruptured. Which condition is this client at increased risk for? Cord prolapse Placenta previa Chorioamnionitis Abruptio placentae

Chorioamnionitis

A 37-year-old client with hypertension, type 1 diabetes and good glycemic control is pregnant for the third time. Her first child is 4 years old, and her second pregnancy resulted in a stillbirth. She is seen in the antepartum testing unit for a nonstress test (NST) at 33 weeks' gestation. What are the primary risk factors in the client's history that indicate the need for a nonstress test? Select all that apply. Age older than 35 years The risk for placenta previa The risk for placental insufficiency A history of stillbirth from her last pregnancy Maternal history of hypertension

The risk for placental insufficiency A history of stillbirth from her last pregnancy Maternal history of hypertension

A woman who is admitted to the labor suite has herpes simplex virus type 2 (HSV-2) with active lesions in the perineal area. What should the nurse's plan of care include? Withholding oral fluid intake Discussing the need for formula feeding Obtaining permission for a paracervical block Applying moist compresses to the perineal area

Withholding oral fluid intake

A client exhibits oligohydramnios at 36 weeks' gestation. What newborn complication should the nurse anticipate? Spina bifida Imperforate anus Tracheoesophageal fistula Intrauterine growth restriction (IUGR)

Intrauterine growth restriction (IUGR)

In her 36th week of gestation, a client with type 1 diabetes delivers a 9 lb 10 oz (4366 g) infant via cesarean birth. For which condition should the nurse monitor this infant of a diabetic mother? Meconium ileus Physiologic jaundice Respiratory distress syndrome Increased intracranial pressure

Respiratory distress syndrome

While reviewing laboratory results of clients seen at the maternity clinic, the nurse notes that one client's maternal serum alpha-fetoprotein level is lower than expected. What does the nurse recognizes that this may be associated with? Fetal demise Down syndrome Neural tube defects Esophageal obstruction

Down syndrome

The nurse is developing a care plan for a client with postpartum psychosis. Which priority intervention should the nurse implement? Teaching the client about normal newborn care Ensuring adequate bonding time with the infant Giving the client time and space to express her feelings Referring the client to a psychiatric healthcare provider as prescribed

Referring the client to a psychiatric healthcare provider as prescribed

At 12 weeks' gestation a client who is Rh negative expels the total products of conception. What is the nursing action after it has been determined that she has not been previously sensitized to Rh-positive red blood cells? Administering Rho(D) immune globulin within 72 hours Making certain that Rho(D) immune globulin is administered at the first clinic visit Withholding the Rho(D) immune globulin because the gestation lasted only 12 weeks Withholding the Rho(D) immune globulin because it is not indicated after fetal death

Administering Rho(D) immune globulin within 72 hours

A nurse on the high-risk unit assesses a client admitted with severe preeclampsia. The client has audible crackles in the lower left lobe, slight blurring of vision in the right eye, generalized facial edema, and epigastric discomfort. Which clinical manifestation indicates the potential for a seizure? Audible crackles Blurring of vision Epigastric discomfort Generalized facial edema

Epigastric discomfort

At 37 weeks' gestation a client's membranes spontaneously rupture; however, she does not have any labor contractions. What action is most important in the nursing plan of care for this client? Monitoring for the presence of fever Monitoring for signs of preeclampsia Monitoring for heavy vaginal bleeding Making preparations for fetal scalp pH sampling

Monitoring for the presence of fever

A client is scheduled to have a vacuum curettage abortion because of fetal demise at 16 weeks of gestation. The primary healthcare provider prescribes a dinoprostone suppository to initiate softening, effacement, and dilation of the cervix (ripening). What should the nurse teach the client about the procedure? "You'll be under general anesthesia for insertion of the suppository." "You'll experience copious bleeding for several hours after the abortion." "A temperature of more than 100° F is common for the first 24 to 48 hours." "After the suppository has been inserted, you should lie flat in bed for 15 minutes."

"After the suppository has been inserted, you should lie flat in bed for 15 minutes."

A client at 32 weeks' gestation visits the prenatal clinic because she is experiencing uterine contractions. She is to be treated at home with restricted activity and long periods of bed rest. Which instructions should the teaching plan include when the client is advised to remain in bed? "Raise the foot of the bed on blocks." "Sit with several large pillows supporting the back." "Assume a side position, with the head raised on a small pillow." "Assume the knee-chest position several times a day for a few minutes."

"Assume a side position, with the head raised on a small pillow."

A client attending the prenatal clinic for a follow-up appointment has been diagnosed with mild preeclampsia. How should the nurse instruct the client regarding her fluid and nutritional intake? "Restrict fluid intake." "Stay on a low-salt diet." "Continue the pregnancy diet." "Increase carbohydrate consumption."

"Continue the pregnancy diet."

The nurse is teaching expectant parents about infant development. Which parental statements indicate the need for further education? Select all that apply. "My baby will enjoy sucking on a pacifier." "Toilet training is an expectation during infancy." "A chronic illness shouldn't impact my baby's development." "My baby will begin to realize that he or she is separate from me early in infancy." "If my wife experiences postpartum depression this could impact my baby's development."

"Toilet training is an expectation during infancy." "A chronic illness shouldn't impact my baby's development." "My baby will begin to realize that he or she is separate from me early in infancy."

A nurse is giving discharge instructions to a new mother. What is the most important instruction to address the prevention of postpartum infection? "Don't take tub baths for at least 6 weeks." "Wash your hands before and after changing your sanitary napkins." "Douche with a dilute antiseptic solution twice a day and continue for a week." "Tampons are better than sanitary napkins for inhibiting bacteria in the postpartum period."

"Wash your hands before and after changing your sanitary napkins."

A client undergoes a cesarean birth because of cephalopelvic disproportion. What care is needed for this client in addition to the routine nursing care given to all postpartum clients during the first 24 hours? Encouraging early ambulation Assessing the fundus gently but firmly Checking vital signs for evidence of shock Administering the prescribed pain medication

Administering the prescribed pain medication

What is the priority nursing intervention during the first 2 hours after a cesarean birth? Evaluating fluid needs to maintain optimum hydration Monitoring the incision to help prevent the onset of infection Encouraging bonding to promote mother-infant interaction Assessing the lochia to identify the complication of hemorrhage

Assessing the lochia to identify the complication of hemorrhage

A pregnant client with a history of preterm labor is at home on bed rest. Which instructions should be included in this client's teaching plan? Place blocks under the foot of the bed Sit upright with several pillows behind the back Lie on the side with the head raised on a small pillow Assume the knee-chest position at regular intervals throughout the day

Lie on the side with the head raised on a small pillow

Hydramnios is diagnosed in a primigravida at 35 weeks' gestation. For what condition should the nurse assess the newborn? Cardiac defect Kidney disorder Diabetes mellitus Esophageal atresia

Esophageal atresia

A resident primary healthcare provider in the birthing unit asks the nurse to prepare for a vaginal examination on a client with a low-lying placenta who is in early labor. What is the priority nursing action at this time? Preparing an intravenous piggyback of oxytocin Explaining why a vaginal examination should not be performed Obtaining an internal monitor to be applied during the examination Having equipment ready for a fetal scalp pH after the examination

Explaining why a vaginal examination should not be performed

Which of the following variables are scored on a biophysical profile? Select all that apply. Fetal tone Fetal position Fetal movement Amniotic fluid index Fetal breathing movements Contraction stress test results

Fetal tone Fetal movement Amniotic fluid index Fetal breathing movements

The nurse is caring for a client during active labor. The recording on the electronic fetal monitor indicates fetal tachycardia. What should the nurse consider as a potential cause of this pattern? Fetal head compression Umbilical cord compression Increased maternal metabolism Pudendal anesthesia administration

Increased maternal metabolism

A woman is admitted to the high-risk unit in preterm labor at 30 weeks' gestation. Which factor does the nurse suspect precipitated this preterm labor? Android pelvis Incompetent cervix First-time pregnancy Antiseizure medication

Incompetent cervix

What is the priority nursing intervention for a client who has just given birth to her fifth child? Palpating her fundus frequently, because she is at increased risk for uterine atony Offering her fluids, because multiparas generally lose more fluid during labor Assessing her bladder tone, because she is at increased risk for urinary tract infection Performing passive range-of-motion exercises on her extremities, because she is at risk for thrombophlebitis

Palpating her fundus frequently, because she is at increased risk for uterine atony

A client in labor is receiving an oxytocin infusion. Which alteration in client status does the nurse recognize as an adverse reaction resulting from prolonged administration? Change in affect Hyperventilation Water intoxication Increased temperature

Water intoxication

A client is admitted to the birthing suite with a blood pressure of 150/90 mm Hg, 3+ proteinuria, and edema of the hands and face. A diagnosis of severe preeclampsia is made. What other clinical findings support this diagnosis? Select all that apply. Headache Constipation Abdominal pain Vaginal bleeding Visual disturbances

Headache Abdominal pain Visual disturbances

The nurse is caring for a client whose fetus is in a breech presentation. The membranes rupture and meconium appears in the vaginal introitus. What does the nurse recognize this to indicate? A potential for cord prolapse Evidence of fetal heart abnormalities A common occurrence in breech presentations A condition requiring immediate notification of the primary healthcare provider

A common occurrence in breech presentations

A 29-year-old gravida 3 para 3 client was admitted to the recovery unit 2 hours after the birth of a 9-lb (4082-g) baby. The nurse assesses the client an hour later and finds her fundus, which is slightly boggy, three fingerbreadths above the umbilicus and displaced to the right. The peripad, which was changed before the client's transfer, is now saturated. What does the nurse recognize? Diastasis recti A distended bladder A probable perineal infection Uncontrolled postpartum pain

A distended bladder

A nurse is caring for a client with severe preeclampsia who is receiving magnesium sulfate. What adverse effects indicate that the serum magnesium level may be excessive? Select all that apply. Absence of the knee-jerk reflex Urine output of 100 mL/hr Blood pressure of 140/90 mm Hg Apical pulse of 80 beats/min Respiratory rate of 11 breaths/min

Absence of the knee-jerk reflex Respiratory rate of 11 breaths/min

A client is admitted with a diagnosis of preeclampsia. Which significant clinical finding does the nurse expect when reviewing the client's history? Proteinuria Tachycardia Increased serum glucose Tonic-clonic movements

Proteinuria

A client at 12 weeks' gestation arrives in the prenatal clinic complaining of cramping and vaginal spotting. A pelvic examination reveals that the cervix is closed. Which probable diagnosis should the nurse expect? Missed abortion Inevitable abortion Incomplete abortion Threatened abortion

Threatened abortion

Which drug may be used to treat postpartum hemorrhage? Dinoprostone Clomiphene Menotropins Methylergonovine

Methylergonovine

The nurse is caring for a patient who has just had an amniotomy performed by the primary healthcare provider. The fetal heart rate immediately decreases from 140 to 80 beats/min. What is the priority nursing action? Inspecting the vagina Administering oxygen Increasing the intravenous fluids Placing the client in the knee-chest position

Inspecting the vagina

A client with poorly controlled type 1 diabetes is now in her thirty-fourth week of pregnancy. The primary healthcare provider tells her that she should have an amniocentesis at 37 weeks to assess fetal lung maturity and that induction of labor will be initiated if the fetus's lungs are mature. The client asks the nurse why an early birth may be necessary. How should the nurse reply? "You'll be protected from developing hypertension." "Your glucose level will be hard to control as you reach term." "The baby will be small enough for you to have a vaginal birth." "The chance that your baby will have hypoglycemia will be reduced."

"Your glucose level will be hard to control as you reach term."

A nurse is caring for four mother-baby couplets on the postpartum unit. Which new mother is at the greatest risk for postpartum hemorrhage? A primipara who has given birth to an 8-lb baby A grand multipara who experienced a labor that lasted 1 hour A multipara whose placental separation occurred 10 minutes after she gave birth A primipara who received epidural anesthesia throughout the birthing experience

A grand multipara who experienced a labor that lasted 1 hour

Which client is at the greatest risk for a postpartum infection? A primipara who gives birth to an infant weighing more than 8.5 lb A woman who required catheterization after voiding less than 75 mL A multipara with a hemoglobin level of 11 g at the time of admission A woman who loses at least 350 mL of blood during the birthing process

A woman who required catheterization after voiding less than 75 mL

A client at 35 weeks' gestation who has had no prenatal care arrives in labor and delivery and is found to be 20% effaced and 2 cm dilated. Her membranes are intact and contractions are 3 minutes apart. The nurse notices some ruptured blisterlike vesicles in the genital area. What should the nurse's next action be? Educating the client on what to expect during labor Discussing pain management options available during labor Discussing the possibility of using oxytocin to move labor along Contacting the primary healthcare provider regarding the need for a cesarean birth

Contacting the primary healthcare provider regarding the need for a cesarean birth

What signs and symptoms of withdrawal does the nurse identify in a postpartum client who has a history of opioid abuse? Paranoia and evasiveness Extreme hunger and thirst Depression and tearfulness Irritability and muscle tremors

Irritability and muscle tremors

A client with preeclampsia is admitted to the labor and birthing suite. Her blood pressure is 130/90 mm Hg, and she has 2+ protein in her urine along with edema of the hands and face. Which signs or symptoms would the client display if she were developing hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome)? Select all that apply. Headache Constipation Abdominal pain Vaginal bleeding Flulike symptoms

Headache Abdominal pain Flulike symptoms

A client who has placenta previa now has started bleeding heavily and is being admitted to the high-risk unit. Why should the nurse place the client in the knee-chest position? It prevents shock It controls bleeding It keeps pressure off the cervix It moves the placenta off the cervix

It prevents shock

A client at 10 weeks' gestation phones the prenatal clinic to report that she is experiencing some vaginal bleeding and abdominal cramping. The nurse arranges for her to go to the local hospital. The vaginal examination reveals that her cervix is dilated 2 cm. What diagnosis should the nurse expect? Septic abortion Inevitable abortion Threatened abortion Incomplete abortion

Inevitable abortion

The husband of a woman who gave birth to a baby 2 weeks ago calls the postpartum unit at the hospital, seeking assistance for his wife. He reports that he found his wife in bed and that the baby was wet, dirty, and crying in the crib. He says, "She says she just can't do it." What is the best response by the nurse? Encouraging him to express his feelings about the situation Telling him to schedule an appointment with the gynecologist Asking whether he can afford a home health aide for several weeks Informing him that he should seek emergency intervention for his wife

Informing him that he should seek emergency intervention for his wife

A client's labor has progressed to the point where she is 6 cm dilated; however, the fetal head is not engaged. An amniotomy is performed. After this procedure, the nurse checks the fetal heart rate. What other nursing action should be performed at this time? Inspecting the perineum Preparing for an immediate birth Measuring the maternal blood pressure Increasing the intravenous (IV) fluid rate

Inspecting the perineum

The nurse is explaining insulin needs to a client with gestational diabetes who is in her second trimester of pregnancy. Which information should the nurse give to this client? Insulin needs will increase during the second trimester. Insulin needs will decrease during the second trimester. Insulin needs will not change during the second trimester. Insulin will be switched to an oral antidiabetic medication during the second trimester.

Insulin needs will increase during the second trimester.

During a home visit the nurse obtains information regarding a postpartum client's behavior and suspects that she is experiencing postpartum depression. Which assessments support this conclusion? Select all that apply. Lethargy Ambivalence Emotional lability Increased appetite Long periods of sleep

Lethargy Ambivalence Emotional lability

Which interventions are included in the nursing care for a client receiving magnesium sulfate for severe preeclampsia? Select all that apply. Monitoring deep tendon reflexes Assessing urine output every 8 hours Maintaining a dark, quiet environment Using a pump to regulate the medication Having calcium gluconate available at the bedside Notifying the primary healthcare provider if the respiratory rate is slower than 20 breaths/min

Monitoring deep tendon reflexes Maintaining a dark, quiet environment Using a pump to regulate the medication Having calcium gluconate available at the bedside

A client at 6 weeks' gestation who has type 1 diabetes is attending the prenatal clinic for the first time. The nurse explains that during the first trimester insulin requirements may decrease for what reason? Body metabolism is sluggish in the first trimester. Morning sickness may result in decreased food intake. Fetal requirements of glucose in this period are minimal. Hormones of pregnancy increase the body's need for insulin.

Morning sickness may result in decreased food intake.

A client's membranes rupture during labor. The nurse immediately assesses the electronic fetal heart rate. Variable decelerations lasting more than 90 seconds, followed by bradycardia, are observed on the monitoring strip. Which physiologic finding does the nurse suspect is the cause of this abrupt change? Fetal acidosis Prolapsed cord Head compression Uteroplacental insufficiency

Prolapsed cord

What are the actions of oxytocin? Select all that apply. Promotes milk ejection during lactation Controls uterine bleeding after delivery Induces labor when uterine contractions are weak Prevents uterine fibrosis in women of reproductive age Prevents high-risk intrauterine fetal positions before delivery

Promotes milk ejection during lactation Controls uterine bleeding after delivery Induces labor when uterine contractions are weak

The nurse is assessing a client with worsening preeclampsia. What is the most significant clinical manifestation of severe preeclampsia? Polyuria Vaginal spotting Proteinuria of 3+ Blood pressure of 130/80 mm Hg

Proteinuria of 3+

A client who is at risk for seizures as a result of severe preeclampsia is receiving an intravenous infusion of magnesium sulfate. What findings cause the nurse to determine that the client is showing signs of magnesium sulfate toxicity? Select all that apply. Proteinuria Epigastric pain Respirations of 10 breaths/min Loss of patellar reflexes Urine output of 40 mL/hr

Respirations of 10 breaths/min Loss of patellar reflexes

During a vertex vaginal birth the nurse notes meconium-stained amniotic fluid. What is the priority nursing intervention for the newborn? Stimulating crying Suctioning the airway Using an Ambu bag with oxygen support Placing the infant in the reverse Trendelenburg position

Suctioning the airway

A client at 36 weeks' gestation is admitted to the high-risk unit with heavy bleeding because of complete placenta previa. Why does the nurse place the client in a lateral Trendelenburg position? To prevent shock To control bleeding To keep pressure off the cervix To move the placenta off the cervix

To prevent shock

Typical signs of neonatal abstinence syndrome related to opioid withdrawal usually begin within 24 hours after birth. What characteristics should the nurse anticipate in the infant of a suspected or known opioid abuser? Select all that apply. Tremors Dehydration Hyperactivity Muscle hypotonicity Prolonged sleep periods

Tremors Hyperactivity

The nurse is assessing her assignment of four postpartum clients. Which conditions increase the risk for postpartum hemorrhage? Select all that apply. Twin birth Overdistended bladder Hypertonic uterine dystocia Retained placental fragments Mild gestational hypertension

Twin birth Overdistended bladder Retained placental fragments

The nurse in the birthing unit is caring for several postpartum clients. Which factor will increase the risk for hypotonic uterine dystocia? Twin gestation Gestational anemia Hypertonic contractions Gestational hypertension

Twin gestation

The nurse is assessing a pregnant client at the end of her second trimester. Which clinical finding causes the nurse to suspect that the client has preeclampsia? Progressive weight gain Two urine samples showing proteinuria Dependent ankle edema during the late afternoon Blood pressure fluctuations on three successive measurements

Two urine samples showing proteinuria The presence of proteinuria in a 24-hour sample or two successive random specimens together with hypertension is indicative of preeclampsia. A gradual weight gain is expected as the uterus and fetus enlarge; abrupt weight gain totaling more than 4.4 lb (2 kg ) in a week may be reflective of preeclampsia. Dependent ankle edema during late afternoon is a common occurrence during the second half of pregnancy and is not a reliable sign of preeclampsia, but when dependent edema does not resolve with 12 hours of bed rest, preeclampsia may be present. Continued increase of blood pressure, not fluctuation in readings, is related to preeclampsia.