OB Exam #2
A nurse notes that a term patient in labor is having late decelerations. Why should the nurse notify the physician? 1. Utero-placental insufficiency 2. Fetal distress 3. Impending delivery 4. Cord Compression
1. Utero-placental insufficiency Rationale: Late decelerations are caused by uteroplacental insufficiency. Cord compression causes variable decelerations. Impending delivery is signaled by crowning of the fetal head.
What symptoms should alert the nurse to the possibility of an ectopic pregnancy? 1. Nausea and vomiting 2. Abdominal pain, vaginal bleeding, and a positive pregnancy test 3. Amenorrhea and a negative pregnancy test 4. Copious discharge of clear mucus
2. Abdominal pain, vaginal bleeding, and a positive pregnancy test Rationale: Abdominal pain, vaginal bleeding, and a positive pregnancy test are signs of an ectopic pregnancy. Amenorrhea and a negative pregnancy test may indicate a metabolic disorder such as hypothyroidism.
The is assisting a patient who just delivered a healthy baby boy weighing 7 pounds. Upon cord traction of placenta, she notices a sudden gushing of a large amount of blood and the fundus is no longer palpable in the abdomen. What are useful nursing interventions if uterine inversion is suspected? 1. Administering oxytocic 2. Assess vital signs 3. Discontinue uterotonic drugs 4. Do not attempt to remove the placenta 5. Establish IV access and fluids
2. Assess vital signs 3. Discontinue uterotonic drugs 4. Do not attempt to remove the placenta 5. Establish IV access and fluids Rationale: Never attempt to remove the placenta if it is still attached, because this will only create a larger surface area for bleeding. When an inversion occurs a large amount of blood suddenly gushes from the vagina. The fundus is not palpable in the abdomen. If the loss of blood continues unchecked, the woman will immediately show signs of blood loss. Uterine inversion may occur after the birth if traction is applied to the umbilical cord too soon or if the pressure is applied to the uterine fundus when the uterus is not contracted. Administering an oxytocic drug only compounds the inversion. Uterotonic drugs should be discontinued to allow uterine relaxation for replacement. IV fluids should be commenced to support blood pressure.
Which is the normal lochial appearance in the first 24 hours after birth? 1. Large clots or tissue 2. Bright red blood 3. A foul odor 4. Absence of lochia
2. Bright red blood Rationale: Normal lochia in the first 24 hours after birth consists of bright red blood.
A nurse is reviewing her assignments. Which patient should she assess first? 1. A 12-hour infant who is small for gestational age. 2. Four hour infant with a cardiac defect. 3. 9 hour old infant who has not voided 4. 3 day old infant waiting for discharge
2. Four hour infant with a cardiac defect Rationale: The infant with a cardiac defect is at the most risk for complications and should be assessed first.
A woman is in the 16th week of pregnancy, and she asks the nurse why she is to be given RhoGAM. Which is the best response by the nurse? 1. It prevents your blood from mixing with the blood of baby. 2. It prevents your body from producing antibodies to the baby's blood type. 3. It prevents the body from developing jaundice because of blood incompatibility. 4. It binds to your blood.
2. It prevents your body from producing antibodies to the baby's blood type. Rationale: RhoGAM prevents the mother from forming antibodies to the fetus's Rh+ blood. Sensitization may occur during pregnancy, birth, abortion, and amniocentesis. Iso- immunization occurs when a Rh negative mother becomes pregnant with a Rh-positive infant, resulting in Rh incompatibility. If mother forms antibodies against Rh, the antibodies could cause hemolysis and jaundice in the next fetus. Jaundice within the first 24 hours of life is a sign of hemolytic disease of the newborn. Physiologic jaundice normally occurs after 24 hours.
A patient has meconium-stained amniotic fluid. Fetal scalp sampling indicates a blood pH of 7.12 and fetal bradycardia is present. Based on these findings, the nurse should take which action? 1. Administer amnioinfusion. 2. Prepare for cesarean section. 3. Reposition the patient. 4. Start IV as prescribed.
2. Prepare for cesarean section. Rationale: Infants with meconium-stained amniotic fluid may have respiratory difficulties and bradycardia at birth. Based on this assessment, fetal metabolic acidosis is present. These findings pose a great threat to the newborn's well-being. A cesarean section is required. Amnioinfusion is an infusion of sterile isotonic solution into the uterine cavity during labor to reduce umbilical cord compression. This is also done to dilute meconium in the amniotic fluid, reducing the risk that the infant will aspirate thick meconium at birth. The procedure is not sufficient in this scenario neither is the IV.
Which behavior indicates that the delivery is imminent and that the physician should be summoned immediately? 1. Decreased duration of contractions 2. Sense of rectal pressure 3. Increase in fetal heart rate 4. Episodes of nausea and vomiting
2. Sense of rectal pressure Rationale: Rectal pressure indicates that the patient is moving into the second stage of labor.
Average expected weight gain during pregnancy?
25-35 lbs
At 32 weeks' gestation a 15-year-old primigravid client who is 5'2", has gained 20 lbs, with a 1 lb weight gain in the last 2 weeks. Urinalysis reveals negative glucose and a trace of protein. The nurse should advise the client that which of the following factors increases her risk for preeclampsia? 1. Total weight gain 2. Short stature 3. Adolescent age group 4. Proteinuria
3. Adolescent age group Rationale: Client's with increased risk for preeclampsia include primigravid clients younger than 20 years or older than 40 years, clients with 5 or more pregnancies, women of color, women with multifetal pregnancies, women with diabetes or heart issues. A total weight gain of 20 lbs in the at 32 weeks gestation with a 1 lb weight gain in the last 2 weeks is within normal limits. Trace amounts of protein in the urine is common during pregnancy but amounts of +1 or more may be pregnancy induced hypertension.
A patient who is 32 weeks pregnant presents to the emergency department with painless, bright red bleeding. What should the nurse do first? 1. Assess BP 2. Perform a pelvic exam 3. Assess fetal heart rate 4. Order a hemoglobin and hematocrit.
3. Assess fetal heart rate Rationale: For patients with 3rd trimester vaginal bleeding, assess the fetal heart rate for decelerations or tachycardia. The nurse should not perform a pelvic exam because of the possibility of placenta previa, which presents as painless, bright red bleeding. Assess the BP after the fetal heart rate pattern. Hematocrit and hemoglobin are usually normal after acute bleeding for a few hours.
A nurse is instructing a patient on signs and symptoms of labor. Teaching was effective if the patient says which? 1. I will call my physician when I feel increased pelvic pressure. 2. I will call my physician when I pass my mucous plug. 3. I will call my physician when my contractions occur every 5 minutes for an hour. 4. I will call my physician when I have bloody show.
3. I will call my physician when my contractions occur every 5 minutes for 1 hour. Rationale: Contractions that occur regularly for an hour indicate the onset of labor. True labor causes contractions that are regular with decreasing intervals between contractions, contractions increase in intensity and duration, and the cervix dilates and effaces. Contractions every 3 to 4 minutes are a sign of active labor. Blood show occurs 24-48 hours before the onset of labor. Lightening occurs when the fetus settles into the pelvic inlet and usually occurs 2 weeks before labor.
A nurse is caring for patients on the postpartum unit. Which patient is highest risk for postpartum hemorrhage? 1. Patient who received fundal massage 2. Patient with engorged breasts 3. Patient who gives oxytocin 4. Patient with a distended bladder
4. Patient with a distended bladder Rationale: A distended bladder will displace uterus to left or right and may prevent the uterus from fully contracting. An episiotomy can cause discomfort but is not a risk factor for hemorrhage. Fundal massage helps reduce postpartum bleeding.
When should urinalysis be done during pregnancy?
A urine specimen for glucose and protein determinations should be obtained at every prenatal visit.
When during pregnancy is gonorrhea screening done?
A vaginal test is done during the initial prenatal examination to screen for gonorrhea. The test may be repeated during the third trimester in high-risk clients.
What is absence of menses by age 16?
Amenorrhea
How should the body be delivered after nunchal cord has been excluded?
Apply gentle traction on the anterior shoulder, advising the client not to push.
What is the Apgar scoring system?
Assesses 5 items to be scored and add the points to determine the newborn's total score. The newborn's Apgar score is assessed and recorded at 1 minute and at 5 minutes after birth.
What are the assessments for stage 2 of labor?
Cervical dilation is complete. Progress of labor is measured by descent of the fetal head through the birth canal (fetal station). Uterine contractions occur every 2 to 3 minutes, lasting 60-75 seconds, and strong. Mother feels urge to bear down.
What is lochia?
Discharge from the uterus that consists of blood from the vessels of the placental site and debris from the decidua, lasts 2 to 3 weeks after delivery.
What is the neonatal breastfeeding schedule?
Every 2 to 3 hours.
At what time should a woman take her temperature when using the basal body temperature method of contraception?
Every morning upon waking and before activity.
What is fetal expulsion?
Expulsion is the birth of the body of the infant.
What are the indications for rubella vaccine after pregnancy?
Give subcutaneously before hospital discharge to a non-immune postpartum client with a rubella titer is less than 1:8.
What type of pelvis is the normal female pelvis?
Gynecoid pelvis.
What are risks for premature rupture of membranes?
Infection, multiple gestations, trauma, and incompetent cervix.
What are the disadvantages of epidural anesthesia?
Maternal hypotension and 10-20 minutes to take effect.
What are the neonatal signs of respiratory distress and hypoxemia?
Nasal flaring, severe retractions, grunting, cyanosis,. Bradycardia or apnea for more than 15 seconds.
How is reflex inability scored for the Apgar?
No response to stimulation 0 points. Grimace/feeble cry when stimulated 1 point. Cry or pull away score 2 points.
What fetal maneuver will encourage fetal rotation from occiput posterior to occiput anterior?
Placing the mother on all fours.
What is premature rupture of membranes?
Premature rupture of the membranes is spontaneous rupture of the amniotic membrane before the onset of labor. When the rupture of membranes is before term infection becomes a risk.
What is the function of amniotic fluid?
Protects the fetus from injury, provides an even temperature for the fetus, and helps dilate the cervix in labor.
What are the assessments for meconium aspiration syndrome?
Respiratory distress at birth; tachypnea, cyanosis, retractions, nasal flaring, grunting, crackles, and rhonchi. Nails, skin, and umbilical cord may be stained yellow-green.
Absence of menses for 6 months or more in a client with prior normal menses is known as?
Secondary amenorrhea
What disorder of pregnancy is characterized by BP >160/110, proteinuria >5000, or 3-4+ on dipstick?
Severe preeclampsia
What is the normal postpartum temperature?
Temperature may increase to 100.4 because of inflammation associated with delivery. Higher temperature elevations may be caused by infection.
What hormones are secreted by the corpus luteum?
The corpus luteum secretes estrogen and progesterone during the remaining 14 days of the cycle.
What are the interventions for the contraction stress test?
The external fetal monitor is applied to the client and a 20-minute baseline strip is recorded. The uterus is stimulated with (Pitocin) or by having the client nipple stimulate until 3 contractions with a duration of 40 seconds or more in a 10-minute period have been achieved.
What is the luteal phase of the menstrual cycle?
The luteal phase begins with ovulation. Body temperature drops and then rises by 0.5 degrees after ovulation. The corpus luteum is formed from follicle cells that remain in the ovary following ovulation.
What does a non-stress test do?
The non-stress test checks for increases in the baby's heart beat with fetal movements.
What is the postpartum period?
The postpartum period starts immediately after delivery and is usually completed by week 6 after delivery.
What is the rooting reflex?
Touching the newborn's lip, cheek, or corner of the mouth with a nipple causes the newborn to turn the head toward the nipple and open mouth. The newborn takes hold of the nipple and sucks. The rooting reflex usually disappears 3 to 4 months.
How does true labor differ from false labor?
True labor produces regular contractions, pelvic pain, progressive fetal dissent, blood show, and progressive cervical effacement and dilation.
What is the Nitrazine test?
Used to detect the presence of amniotic fluid. Vaginal secretions have a pH of 4.5-5.5 and do not affect the Nitrazine strip or swab. Amniotic fluid has a pH of 7-7.5 and turns the Nitrazine strip blue.
When during pregnancy does ankle edema occur?
Usually occurs in the second and third trimesters. Results from venous stasis and increased venous pressure caused by uterine enlargement.
What are the assessments for stage 4 of labor?
-Blood pressure returns to prelabor level. -Fundus remains contracted in the midline. -1 or 2 finger breadths below the umbilicus. -Monitor the lochia discharge. -Lochia may be moderate in amount and red in color in stage 4.
What are the assessments for newborns with diabetes?
-Excessive size and weight -Edema or puffiness in the face and cheeks -Signs of hypoglycemia -Twitching/difficulty feeding, lethargy -Hyperbilirubinemia.
A patient in labor is 8 cm dilated. The fetus is vertex and at the ischial spines. Which is the station of the fetus? 1. 0 station 2. +1 station 3. -1 station 4. +2 station
1. 0 station Rationale: Station refers to the level of the presenting part in relation to the pelvic inlet and the ischial spines. 0 station indicates that the presenting part is at the level of the ischial spines. Other stations are defined by their distance in centimeters above or below the ischial spines up to 5+ at the introitus. Negative is above the spines. Positive is below the spines.
A nurse gives fentanyl 50 mcg IV for a patient in labor. Which fetal heart rate pattern should the nurse anticipate? 1. Decreased variability 2. Variable decelerations 3. Late decelerations 4. Early decelerations
1. Decreased variability Rationale: Fentanyl may cause decreased fluctuations in the baseline fetal heart rate; Fentanyl crosses the placenta and is a CNS depressant. Early decelerations have an onset before the peak of the contraction and result from fetal head compression.
A mother is 11 weeks pregnant and presents for her first prenatal care visit. Which test is the most appropriate? 1. Hemoglobin A1c 2. Triple screen 3. Coombs Test 4. Amniocentesis
1. Hemoglobin A1c Hemoglobin A1C test screens for gestational diabetes. This test is recommended for all pregnant women at the first prenatal test. Triple screen is a blood study done between 15 & 20 weeks gestation that detects chromosomal abnormalities. The indirect Coombs test screens maternal blood for anti-RBC antibodies. Amniocentesis is needle aspiration of fluid from the sac to detect fetal abnormalities.
When does the uterus return to the pelvic cavity after birth? 1. 2 weeks postpartum 2. 7-9 days postpartum 3. 6 weeks postpartum 4. When lochia changes to alba
2. 7-9 days postpartum Rationale: The uterus involutes and returns to the pelvic cavity after 7-9 days. Failure of the uterus to return to the pelvic cavity is subinvolution.
How many chromosomes present in the ovum and sperm?
23 each
A patient in labor has red amniotic fluid. What does this finding suggest? 1. Normal amniotic fluid 2. Increased bloody show 3. Abruptio placentae 4. Meconium
3. Abruptio placentae Rationale: Red amniotic fluid is a sign of abruptio placentae, which is a premature separation of the placenta from the uterine wall. Increased bloody show is normal and causes pink amniotic fluid.
A patient is admitted to the labor and delivery unit. The patient says, "my water just broke." Which action should the nurse take first? 1. Notify physician 2. Check pH of amniotic fluid 3. Document characteristics of amniotic fluid. 4. Check fetal heart rate.
4. Check fetal heart rate Rationale: Normal baseline FHR 120-160 bpm. Tachycardia is above 160 bpm is an early sign of fetal hypoxia.
A nurse is caring for a patient undergoing augmentation of labor. The nurse notes 3 consecutive late decelerations on the fetal monitor. Which action should the nurse take? 1. Increase infusion of lactated ringer's solution 2. O2 mask at 10 L 3. Place patient on left side 4. Turn off infusion of oxytocin (Pitocin)
4. Turn off infusion of oxytocin (Pitocin) Rationale: Fetal hypoxia is treated with measures to increase oxygen flow to fetus, such as increasing fluids, oxygen, turning off pitocin, and placing the mother in the left lying position.
What is the normal postpartum pulse?
50 BPM. Pulse >1000 BPM indicates excessive blood loss or infection.
When does the third stage of labor end?
After delivery of the placenta
What assessments should be made for heavy third trimester vaginal bleeding?
Assess maternal vital signs and fetal heart rate.
What is preterm labor?
Before 37 weeks
What are the physiological maternal blood pressure changes of pregnancy?
Blood pressure slightly decreases in the 2nd trimester.
What is the significance of blood in the amniotic fluid?
Bloody amniotic fluid may indicate abruptio placentae or fetal trauma. An unpleasant odor to amniotic fluid is associated with infection.
What is the role of amniotic fluid?
Consists of 800-1200 mL by the end of pregnancy. Amniotic fluid surrounds, cushions, and protects the fetus and allows for fetal movement. The amniotic fluid maintains the body temperature of the fetus.
What are the assessment for premature rupture of membranes?
Fluid pooling into a vaginal vault; Nitrazine test is positive. Assess the amount, color, consistency, and odor of fluid. Elevated temperature may indicate the presence of infection. Fetal tachycardia is a sign of infection.
What is the evaluation of fundal height?
Fundal height is measured to evaluate the gestational age of the fetus.
What is the adverse effect of Narcan in opioid dependent clients?
It can cause withdrawal.
What is the normal intrauterine fetal attitude?
It is the relationship of the fetal body parts to one another. The normal intrauterine attitude is flexion, in which the fetal back is rounded, the head is forward on the chest, and the arms and legs are folded in against the body.
What position should the client be placed in for an epidural?
Lateral left with legs flexed and back curved.
What is the fetal presentation?
Part of the fetus that enters the pelvic inlet first. The cephalic presentation is the normal presentation.
What is the fundal height measurement method?
Place the client in the supine position. Place the end of the tape measure at the symphysis pubis and measure to the top of the uterine fundus.
What intervention is indicated for a pregnant client with late decelerations?
She should lie on her left side, oxygen should be given, and the physician should be notified immediately.
What is stage 1 of labor?
Stage 1 is the longest stage of labor. Cervical dilation is 1-4 cm. Uterine contractions occur every 15 to 30 minutes, are 15 to 30 seconds in duration and are of mild intensity.
What is peripartum supine hypotension?
Supine hypotension occurs when the venous return to the heart is impaired by the weight of the uterus on the vena cava.
How do contractions change during the transition phase of labor?
They increase in frequency, intensity, and duration.
In which trimester is UTI most common?
Third trimester
What routine interventions decrease the risk of postpartum hemorrhage?
Uterine fundal massage and postpartum oxytocin.
What are some interventions for varicose veins during pregnancy?
Wearing support hose. Elevating the feet when sitting. Lying with the feet and hips elevated. Avoiding long periods of standing or sitting. Avoid leg crossing. Avoid contracting articles of clothing.
At what time after delivery should RhoGAM be administered in the postpartum period?
Within 72 hours after delivery.
