Final OB Exam

What would the nurse expect to find when assessing the fundus of the uterus immediately after delivery?

Well-contracted with its upper border at or just below the umbilicus

The labor and delivery 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

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? Select all.

When growth spurts and dietary increases are expected

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 tracings

What statement made by a new mother indicates she needs additional information about breastfeeding?

"If the baby gets fussy between feedings, I give her a bottle of water"

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 will add a little water to the formula if I am running low."

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."

When assessing the patient's cervical dilatation, which factors are included in the exam?

-Cervix dilation from 0-10 -effacement: thickness of the cervix from 0-100% -station: level the head is at in relations to the ischial spines

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.

-Use a mild preservative-free soap with a neutral pH -Daily bathing with soap is not necessary fro the newborn -Genital and rectal areas should be cleaned at each diaper changes -Avoid the use of soap on the face of the newborn

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.

-a vaccination is an example of acquired immunity -natural passive immunity protects the baby for a few months after birth -placental transfer is how newborns get natural passive immunity

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.

-case manager -social worker -respiratory therapist -home health agency nurse

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

-delay administration of eye ointment until parents have held newborn -explain expected neonatal characteristics such as molding, milia, and lanugo -initiate skin-to-skin contact with a warm blanket over the neonate and parent

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.

-do simple household chores, such as vacuuming or washing the dishes -place the baby in a safe place and allow the baby to cry from 10 to 15 minutes

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.

-dyspnea -jaundice -macrosomia -hypocalcemia

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.

-frequent, painful urination -foul-smelling lochia -hot, red, painful breasts

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.

-infants need to be dressed to prevent infants from overheating during sleep -during pregnancy, women should not smoke, drunk alcohol, or use illegal drugs -parents need to avoid products that claim to reduce the risk of SIDS -parents should not smoke or allow smoking around their baby -mothers need to be informed that breastfeeding reduces the risk of SIDS. (all of them)

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.

-keep the baby wrapped in a warm blanket -position the baby away from vents and drafts -place a stocking cap on the neonate's head -change wet clothing immediately

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

-pregnancy should be avoided for 4 weeks -the risks to the fetuses of any future pregnancies -the patient will need to be immunized before discharge

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.

-the father exhibited depression during the pregnancy -the birth of this fourth child was unexpected and unplanned -the father spends more time than usual at work

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 an amnioinfusion through the IUPC, and once the fetus has improved, contractions need to be augmented to be more effective

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 a neutral pH cleanser and sterile water for bathing -gently apply emollients to avoid unnecessary friction -use water, air, or gel mattresses

A postpartum patient informs the nurse o 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.

-use of a vacuum extractor -neonatal macrosomia -poor oral fluid intake -urinary catheter during labor

A patient presented to labor and delivery for an induction. Her bishops score was an 8 and is ready to begin an infusion of Pitocin. You receive a 1000mL bag of Lactated Ringers with 20 units of Pitocin in it. The order is to start the infusion at 0.5mU/min and increase by 1mU/min every 20 minutes until contractions are 3 minutes apart. What is the initial rate of infusion you would set your pump in mL/hr?

1.5

The umbilical cord is composed of?

2 arteries carrying blood away from the fetus and 1 vein carrying blood to the fetus

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

25-35 pounds

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 as being red in color

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

Asymmetrical Moro reflex

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 the mother to express grief in her own way

A multiparous patient reports severe uterine cramps in 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

In what situation will the physician order RhoGAM?

An unsensitized Rh-negative mother has an Rh-positive infant

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 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 the patient 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 order

What should the nurse's first action be when postpartum hemorrhage from uterine atony is suspected?

Begin massaging the fundus while another person notifies the physician

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 to 12 months

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 to 12 months

A primipara tells the nurse, "My afterpains get worse when I am breastfeeding." What is the most appropriate nursing response?

Breastfeeding releases a hormone that causes your uterus to contract

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

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 an antipruritic medication

The nurse is assisting the primary care provider with the third stage of vaginal delivery. The patient is multiparous, experienced a precipitous birth, and has a history of hypertension. The patient is suffering from postpartum hemorrhage in which she has already received two doses of oxytocin. Which medical prescription does the nurse anticipate for this patient.

Carboprost-tromethamine (Hemabate)

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 nurse-preceptor is explaining to a new nurse about the fetal heart monitoring. The mother is carrying twins. 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 the maternal radial pulse is being recorded correctly

What instruction should the nurse teach the postpartum woman about perineal self-care?

Cleanse with warm water in a squeeze bottle from front to back

Stage two labor is defined as?

Complete cervical dilation and ends with delivery of baby

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 completing all assessments and providing comfort measures?

Contact the primary care provider for further evaluation

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?

Denial

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 healthcare provider that Chrissy is GBS positive and therefore 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 the neonate immediately

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 patient to drink 1 to 2 quarts of water before the test

The nurse in a postpartum unit frequently teaches patients regarding breast care. Which teaching is most helpful to the breastfeeding patient who is experiencing primary engorgement?

Express milk by a breast pump or manually

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

False

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

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

After a prolonged labor, a woman vaginally delivered a 10-pound, 3-ounce infant boy. What complication should the nurse be alert for in the immediate postpartum period?

Hematoma

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 unit

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. What specific discharge teaching will the nurse provide regarding pain management?

Information applicable to medication therapy

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

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

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 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 surgery

What is the most common site for fertilization?

Outer third of the fallopian tube near the ovary

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 55 mmHg on 90% oxygen

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 maternal abdomen during a contraction

While providing care for a patient who is constantly changing positions, the nurse notices an erratic FHR recording. What action should the nurse take next?

Place the transducer(ultrasound) in a different position

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

Provide a neutral temperature environment

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 presenting information to the new parents regarding screening of their newborn. What information does the nurse identify as being MOST important to the parents?

Screenings are for infections, genetic diseases, and inherited disorders

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?

The fetal head is currently engaged in the maternal pelvis (at the ischial spines)

The nurse notices that a new mother has her neonate unwrapped and undressed "to check out the baby." For which reason does the nurse conclude the neonate is at risk for cold stress?

The 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?

The neonate with a birth weight of 4,100 g

The patient in the latent phase of labor has been contracting for approximately half an hour. She wants to know what she can do the get her contractions to become more frequent and stronger. What would be the most appropriate response from the nurse?

Walking can increase you contractions and make them stronger

A patient desires to have a medication free delivery. She asks the nurse what her options are for pain relief during labor. The nurse would offer which of the following options?

Warm shower of bath, guided imagery, effleurage, various positioning

The nurse is preparing a postpartum patient who had a precipitous birth, for discharge. Which patient teaching is most important for the nurse to provide?

The signs and symptoms of postpartum hemorrhage

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 at least six to eight wet diapers and several stools per day

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

To prevent uterine inversion

A newborns normal heart rate is 100-160 bpm and respiratory rate is 30-60 bpm.

True

White, pimple-like spots called millia on a newborn's face is normal.

True

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 what reason does the nurse explain the need for these vaccinations?

Vaccinating the mother will protect the neonate and future pregnancies from serious illnesses

A parent delivers a term neonate and expresses concern about the reason for giving the neonate an injection. Which information from the nurse is accurate?

Vitamin K is needed to activate clotting factors

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

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 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 minutes

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 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

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 has been achieved

True labor is when...

the cervix dilates

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 a fetal demise

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